Primary Care Workforce Access Improvement Act of 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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2015 on the proposed rule that included numerous recommendations, including but not limited to: Urged CMS to conduct physician practice expense to validate the practice expense component of Relative Value Units; There be a standard resource-based relative value scale update committee survey to determine the work and direct practice expense of moderate sedation; CMS use the additional time from the delay in collecting data on global periods to develop a methodology to fairly re-allocate malpractice RVUs for services converting from a 90- or 10-day to a zero-day global period; CMS maintain an objective and transparent formal appeals process that is consistently applied and open to any organizations that would like to comment; CMS investigate the adequacy of payment for physician services that typically take place outside of a face-to-face patient encounter; that the Collaborative Care Model be implemented through a Center for Medicare and Medicaid Innovation Demonstration and be rapidly expanded within Medicare through the Secretarys authority based upon the results and learnings of this demonstration. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers; Urged members of Congress to replace sequestration with a balanced approach to deficit reduction that takes into account the deep cuts NDD has already incurred since 2010. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reporting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful use requirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law earlier this year. The Medicare Primary Care Incentive Program: Advocated to extend this program, which began in 2011 and expires in 2015, that pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. MACRA: Provided comments to CMS regarding implementation of Alternative Payment Models (APMs) and the Merit-Based Incentive Program (MIPs) under the Medicare Access & CHIP Reauthorization Act (MACRA). Comments included: delivery system improvements, avoiding administrative and cost burdens for patients, reducing administrative burdens for physicians, improving current quality and reporting systems, and transparency. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Site-Neutral Payments: ACP provided feedback to Congress on Section 603, Treatment of Off-Campus Outpatient Departments of a Provider, as included in the recently-enacted Bipartisan Budget Act of 2015 (BBA). ACP advocated to expand Section 603 to encompass all outpatient off-campus facilities, not just those HOPDs that are built or purchased after the November 2nd enactment date. Stark Law: ACP provided feedback to Congress that the physician self-referral laws need to be revisited in light of the changes in health care delivery and payment reform. ACP is supportive of increasing payment programs that focus on safe, efficient, value-based care delivery and agree that the Stark Self-Referral Laws should not prevent innovation. Tobacco: ACP provided feedback to Congress to express support for the provision in the Trans-Pacific Partnership (TPP) that gives governments the option to exclude tobacco control measures from Investor-State Dispute Settlement (ISDS) challenges. The provision will protect the rights of current and future TPP participating nations to adopt public health measures that reduce tobacco use without fear of facing lengthy and expensive trade disputes initiated by tobacco companies.

Client expense: $223,814 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), 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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2015 on the proposed rule that included numerous recommendations, including but not limited to: Urged CMS to conduct physician practice expense to validate the practice expense component of Relative Value Units; There be a standard resource-based relative value scale update committee survey to determine the work and direct practice expense of moderate sedation; CMS use the additional time from the delay in collecting data on global periods to develop a methodology to fairly re-allocate malpractice RVUs for services converting from a 90- or 10-day to a zero-day global period; CMS maintain an objective and transparent formal appeals process that is consistently applied and open to any organizations that would like to comment; CMS investigate the adequacy of payment for physician services that typically take place outside of a face-to-face patient encounter; that the Collaborative Care Model be implemented through a Center for Medicare and Medicaid Innovation Demonstration and be rapidly expanded within Medicare through the Secretarys authority based upon the results and learnings of this demonstration. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers; Urged members of Congress to replace sequestration with a balanced approach to deficit reduction that takes into account the deep cuts NDD has already incurred since 2010. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reporting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful use requirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law earlier this year. The Medicare Primary Care Incentive Program: Advocated to extend this program, which began in 2011 and expires in 2015, that pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. MACRA: Provided comments to CMS regarding implementation of Alternative Payment Models (APMs) and the Merit-Based Incentive Program (MIPs) under the Medicare Access & CHIP Reauthorization Act (MACRA). Comments included: delivery system improvements, avoiding administrative and cost burdens for patients, reducing administrative burdens for physicians, improving current quality and reporting systems, and transparency. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Site-Neutral Payments: ACP provided feedback to Congress on Section 603, Treatment of Off-Campus Outpatient Departments of a Provider, as included in the recently-enacted Bipartisan Budget Act of 2015 (BBA). ACP advocated to expand Section 603 to encompass all outpatient off-campus facilities, not just those HOPDs that are built or purchased after the November 2nd enactment date. Stark Law: ACP provided feedback to Congress that the physician self-referral laws need to be revisited in light of the changes in health care delivery and payment reform. ACP is supportive of increasing payment programs that focus on safe, efficient, value-based care delivery and agree that the Stark Self-Referral Laws should not prevent innovation. Tobacco: ACP provided feedback to Congress to express support for the provision in the Trans-Pacific Partnership (TPP) that gives governments the option to exclude tobacco control measures from Investor-State Dispute Settlement (ISDS) challenges. The provision will protect the rights of current and future TPP participating nations to adopt public health measures that reduce tobacco use without fear of facing lengthy and expensive trade disputes initiated by tobacco companies.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2015 on the proposed rule that included numerous recommendations, including but not limited to: Urged CMS to conduct physician practice expense to validate the practice expense component of Relative Value Units; There be a standard resource-based relative value scale update committee survey to determine the work and direct practice expense of moderate sedation; CMS use the additional time from the delay in collecting data on global periods to develop a methodology to fairly re-allocate malpractice RVUs for services converting from a 90- or 10-day to a zero-day global period; CMS maintain an objective and transparent formal appeals process that is consistently applied and open to any organizations that would like to comment; CMS investigate the adequacy of payment for physician services that typically take place outside of a face-to-face patient encounter; that the Collaborative Care Model be implemented through a Center for Medicare and Medicaid Innovation Demonstration and be rapidly expanded within Medicare through the Secretarys authority based upon the results and learnings of this demonstration. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers; Urged members of Congress to replace sequestration with a balanced approach to deficit reduction that takes into account the deep cuts NDD has already incurred since 2010. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reporting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful use requirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law earlier this year. The Medicare Primary Care Incentive Program: Advocated to extend this program, which began in 2011 and expires in 2015, that pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. MACRA: Provided comments to CMS regarding implementation of Alternative Payment Models (APMs) and the Merit-Based Incentive Program (MIPs) under the Medicare Access & CHIP Reauthorization Act (MACRA). Comments included: delivery system improvements, avoiding administrative and cost burdens for patients, reducing administrative burdens for physicians, improving current quality and reporting systems, and transparency. Federal Firearms Research: Advocated for lifting the ban on gun research by CDC (and adequate funding for NIH gun-related research). Clinical Labs: Commented to CMS on Medicares Clinical Diagnostic Laboratory Tests Payment System. Recommendations included: Extending the timeline for implementation & allowing six months before initial reporting, retain the proposed POL low expenditure threshold exclusion, reduce data collection period from 12 months to 3 months. Affordable Care Act Benefit and Payment Parameters: Advocated to CMS that plans offered through health exchanges be required to abide by Federally-Facilitated Marketplace Standards related to data submission, network adequacy, and essential community providers; Advocated that Qualified Health Plans provide a prescription drug plan formulary exception process that provides a pathway to access clinically appropriate drugs not covered by the health plan; Advocated for more stringent quantitative network adequacy criteria. Medicares Physician Fee Schedule: Urged CMS to conduct a new Physician Practice Expense Information Survey to validate the Practice Expense (PE) of the Relative Value Units (RVUs); Advocated there be a standard Resource-Based Relative Value Scale Update Committee survey to determine the work and direct PE inputs of moderate sedation; Use the additional time from the delay in collecting data on global periods to develop a methodology to fairly reallocate malpractice RVUs for services converting from a 90 or 10-day to a zero-day global period.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2015 on the proposed rule that included numerous recommendations, including but not limited to: Urged CMS to conduct physician practice expense to validate the practice expense component of Relative Value Units; There be a standard resource-based relative value scale update committee survey to determine the work and direct practice expense of moderate sedation; CMS use the additional time from the delay in collecting data on global periods to develop a methodology to fairly re-allocate malpractice RVUs for services converting from a 90- or 10-day to a zero-day global period; CMS maintain an objective and transparent formal appeals process that is consistently applied and open to any organizations that would like to comment; CMS investigate the adequacy of payment for physician services that typically take place outside of a face-to-face patient encounter; that the Collaborative Care Model be implemented through a Center for Medicare and Medicaid Innovation Demonstration and be rapidly expanded within Medicare through the Secretarys authority based upon the results and learnings of this demonstration. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers; Urged members of Congress to replace sequestration with a balanced approach to deficit reduction that takes into account the deep cuts NDD has already incurred since 2010. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reporting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful use requirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law earlier this year. The Medicare Primary Care Incentive Program: Advocated to extend this program, which began in 2011 and expires in 2015, that pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. MACRA: Provided comments to CMS regarding implementation of Alternative Payment Models (APMs) and the Merit-Based Incentive Program (MIPs) under the Medicare Access & CHIP Reauthorization Act (MACRA). Comments included: delivery system improvements, avoiding administrative and cost burdens for patients, reducing administrative burdens for physicians, improving current quality and reporting systems, and transparency. Federal Firearms Research: Advocated for lifting the ban on gun research by CDC (and adequate funding for NIH gun-related research). Clinical Labs: Commented to CMS on Medicares Clinical Diagnostic Laboratory Tests Payment System. Recommendations included: Extending the timeline for implementation & allowing six months before initial reporting, retain the proposed POL low expenditure threshold exclusion, reduce data collection period from 12 months to 3 months. Affordable Care Act Benefit and Payment Parameters: Advocated to CMS that plans offered through health exchanges be required to abide by Federally-Facilitated Marketplace Standards related to data submission, network adequacy, and essential community providers; Advocated that Qualified Health Plans provide a prescription drug plan formulary exception process that provides a pathway to access clinically appropriate drugs not covered by the health plan; Advocated for more stringent quantitative network adequacy criteria. Medicares Physician Fee Schedule: Urged CMS to conduct a new Physician Practice Expense Information Survey to validate the Practice Expense (PE) of the Relative Value Units (RVUs); Advocated there be a standard Resource-Based Relative Value Scale Update Committee survey to determine the work and direct PE inputs of moderate sedation; Use the additional time from the delay in collecting data on global periods to develop a methodology to fairly reallocate malpractice RVUs for services converting from a 90 or 10-day to a zero-day global period.

Monitor legislative activity related to health funding; graduate medical education funding; H.R. 487 - Primary Care Workforce Access Improvement Act; H.R. 1180 - Resident Physician Shortage Reduction Act; H.R. 1201 Training Tomorrow's Doctors Today Act; S. 577 - Resident Physician Shortage Reduction Act;

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, 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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2015 on the proposed rule that included numerous recommendations, including but not limited to: Urged CMS to conduct physician practice expense to validate the practice expense component of Relative Value Units; There be a standard resource-based relative value scale update committee survey to determine the work and direct practice expense of moderate sedation; CMS use the additional time from the delay in collecting data on global periods to develop a methodology to fairly re-allocate malpractice RVUs for services converting from a 90- or 10-day to a zero-day global period; CMS maintain an objective and transparent formal appeals process that is consistently applied and open to any organizations that would like to comment; CMS investigate the adequacy of payment for physician services that typically take place outside of a face-to-face patient encounter; that the Collaborative Care Model be implemented through a Center for Medicare and Medicaid Innovation Demonstration and be rapidly expanded within Medicare through the Secretarys authority based upon the results and learnings of this demonstration. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers; Urged members of Congress to replace sequestration with a balanced approach to deficit reduction that takes into account the deep cuts NDD has already incurred since 2010. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Hospital Outpatient Prospective Payment System proposed rule for FY 2016: ACP commented to CMS specifically on section XV of the rule pertaining to Short Inpatient Hospital Stays; Supported the proposed modification that would broaden the exception criteria to allow determination on a case-by-case basis using supporting clinical documentation by the physician responsible for the care of the beneficiary; Supported a revision to the current medical review strategy for short term hospital stays by requiring that Quality Improvement Organization (QIO) contractors conduct the reviews rather than the Medicare Administrative Contractors (MACs); Expressed disappointment that the rule did not more fully address the need for increased beneficiary protections, which would negate or significantly limit adverse financial consequences to beneficiaries who experience stays under observation status, or who have their short inpatient stays denied. Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reporting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful use requirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law earlier this year. The Medicare Primary Care Incentive Program: Advocated to extend this program, which began in 2011 and expires in 2015, that pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Praised members of Congress for the bipartisan effort in finally ending the SGR and for passing H.R. 2. Medicare Physician Fee Schedule: Commented to CMS in Sept. 2015 on the proposed rule that included numerous recommendations, including but not limited to: Urged CMS to conduct physician practice expense to validate the practice expense component of Relative Value Units; There be a standard resource-based relative value scale update committee survey to determine the work and direct practice expense of moderate sedation; CMS use the additional time from the delay in collecting data on global periods to develop a methodology to fairly re-allocate malpractice RVUs for services converting from a 90- or 10-day to a zero-day global period; CMS maintain an objective and transparent formal appeals process that is consistently applied and open to any organizations that would like to comment; CMS investigate the adequacy of payment for physician services that typically take place outside of a face-to-face patient encounter; that the Collaborative Care Model be implemented through a Center for Medicare and Medicaid Innovation Demonstration and be rapidly expanded within Medicare through the Secretarys authority based upon the results and learnings of this demonstration. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers; Urged members of Congress to replace sequestration with a balanced approach to deficit reduction that takes into account the deep cuts NDD has already incurred since 2010. 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. National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers; Urged members of Congress to replace sequestration with a balanced approach to deficit reduction that takes into account the deep cuts NDD has already incurred since 2010. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Hospital Outpatient Prospective Payment System proposed rule for FY 2016: ACP commented to CMS specifically on section XV of the rule pertaining to Short Inpatient Hospital Stays; Supported the proposed modification that would broaden the exception criteria to allow determination on a case-by-case basis using supporting clinical documentation by the physician responsible for the care of the beneficiary; Supported a revision to the current medical review strategy for short term hospital stays by requiring that Quality Improvement Organization (QIO) contractors conduct the reviews rather than the Medicare Administrative Contractors (MACs); Expressed disappointment that the rule did not more fully address the need for increased beneficiary protections, which would negate or significantly limit adverse financial consequences to beneficiaries who experience stays under observation status, or who have their short inpatient stays denied. Health Information Technology: Urged support for H.R. 3309, the Further Flexibility in Health Information Technology (HIT) Reporting and Advancing Interoperability Act (Flex-IT 2 Act); Advocated that CMS pause the implementation of Stage 3 meaningful use requirements until the new Merit-Based Incentive Payment System (MIPS) is ready to be implemented, and shorten the reporting period for the EHR Incentive Payment Programs from twelve months each year to three months. H.R. 3309 would also provide the Secretary of HHS greater flexibility to change, suspend, or revoke meaningful use criteria if the requirements are not consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law earlier this year. The Medicare Primary Care Incentive Program: Advocated to extend this program, which began in 2011 and expires in 2015, that pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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. 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 incentives-both non-financial and financial-for 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 H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system; Advocated for extending the Medicare Primary Care Incentive Program beyond its 2015 sunset date. This program, which began in 2011, pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. 21st Century Cures: Commented on H.R. 6, the 21st Century Cures Act, which provides broad reforms to help incentive innovation and cures for disease; addresses FDA oversight, increased funding for the National Institutes of Health, immunization, the prescription drug approval process, and reforms to Health Information Technology and Electronic Health Records.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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. 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 incentives-both non-financial and financial-for 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 H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system; Advocated for extending the Medicare Primary Care Incentive Program beyond its 2015 sunset date. This program, which began in 2011, pays eligible internal medicine specialists, family physicians, and geriatricians a 10 percent bonus on designated office visits and other primary care services. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress). Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. 21st Century Cures: Commented on H.R. 6, the 21st Century Cures Act, which provides broad reforms to help incentive innovation and cures for disease; addresses FDA oversight, increased funding for the National Institutes of Health, immunization, the prescription drug approval process, and reforms to Health Information Technology and Electronic Health Records.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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. 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 incentives-both non-financial and financial-for 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 nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. 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. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress) Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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. Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act, which would repeal the SGR formula and move to a new value-based payment and delivery system under Medicare. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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. 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 incentives-both non-financial and financial-for 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 nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2016 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. 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. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106 in the 113th Congress), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services.. Workforce: Advocated for H.R. 1201 (113th Congress), The Training Tomorrow's Doctors Today Act, S. 577 (113th Congress), the Resident Physician Shortage Reduction Act of 2013, H.R. 487 (113th Congress), the Primary Care Workforce Access and Improvement Act of 2013 (113th Congress) Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill. HR 1281, Newborn Screening Saves lives Reauthorization Act, Supporting parent and provider newborn screening education programs and research at NIH. HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill. HR 1281, Newborn Screening Saves lives Reauthorization Act, Supporting parent and provider newborn screening education programs and research at NIH. HR 2642, 5-year Farm Bill, FDA, tobacco regulation and nutrition programs. HR 2810, Repeal of Medicare SGR formula, Repeal of SGR to be replaced by a positive payment update and higher rate for primary care, Medicare Physician Payment rate and implementation of alternative payment models. HR 3547, Promoting Teaching Health Centers, AHRQ, Title VII primary care grants and NHSC appropriations, AAFP budget priorities, Title VII Sec 747, Teaching Health Center grants, NHSC, AHRQ. HR 4302 (SGR patch legislation), Advocate for inclusion of policies that benefit primary care, e.g. 9-month length. HR 4302, Protecting Access to Medicare Act, Medicare physician payment rate extended for one year. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1871, SGR Repeal and Medicare Beneficiary Access, Medicare Physician Payment rate and implementation of alternative payment models. S. 1978, Increasing Primary Care Access Act, Family physician workforce. S. 2000, SGR repeal and Medicare provider Payment Modernization, Medicare Physician Payment rate and implementation of alternative payment models. S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. S. 2157, the commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014; advocate for members to mention at E&C hearing. No Bill Number, Telemedicine, educate staff on AAFP's view of telemedicine policies. No Bill Number, Rural physician workforce, Access to care in rural areas; Increased family physician workforce. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, AHRQ 15th anniversary, Promoting primary care research. No Bill Number, President's FY 2015 budget, Federal spending prioritiesto support workforce, research. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, Coalition meetings to promote Medicaid parity payment, extend Medicaid parity for primary care. No Bill Number, HRSA budget, promoting health care access and increase physician workforce. No Bill Number, Medicare physician payment reform of the SGR, 2014 conversion factor. No Bill Number, E-Cigarettes, Urge FDA to regulate all tobacco products. No Bill Number, Graduate Medical Education, Nominate FP's to Council on GME. No Bill Number, Health insurance marketplaces, concerns with 90-day grace period. No Bill Number, Anti-competitive aspects of healthcare, FTC hearing and request for comments on professional regulations role. No Bill Number, Part D formularies, Opposed CMS changes to Part D formularies. No Bill Number, Nomination of Dr. Vivek Murthy for Surgeon General. No Bill Number, Tobacco Cessation Programs, Asking HHS to clearly define a comprehensive tobacco cessation benefit in health insurance coverage. No Bill Number, FY 2015 Federal Budget Proposal, Supporting budget proposals for primary care research, education and training programs. No Bill Number, Competition in Health Care Industries, Recommending state oversight in health care scope of practice and FTC oversight of hospital and insurance consolidations. No Bill Number, Notification of Lapsed Payment of Health Care Insurance Premiums, Revising policy to have insurance plans notify physicians that a patient has not paid on-month's premium. No Bill Number, Primary Care Incentive Payment Revision, Monitoring MedPac recommendation to make PCIP a capitated payment. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act issues. No Bill Number, FTC Healthcare Competition Workshop, Scope of Practice issues. No Bill Number, Hearing of Energy and Commerce Subcommittee on Oversight and Investigations, Implementation of the Affordable Care Act's Health Insurance Marketplaces. No Bill Number, Energy and Commerce Health Subcommittee Hearing on drug shortages, reducing the incidence of local and regional shortage of drugs. No Bill Number, Energy and Commerce Subcommittee on Oversight and Investigations - Hearing on Counterfeit drugs. No Bill Number, Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade - hearing on Sports safety.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill; urge W&M offices to discuss during March 2014 budget hearing. HR 2810, Repeal of Medicare SGR formula, Repeal of SGR to be replaced by a positive payment update and higher rate for primary care. Medicare Patient Access and Quality Improvement Act, Medicare Physician paymnent rate and implementation of alternative payment models. HR 4302 (SGR patch legislation), Advocate for inclusion of policies that benefit primary care, e.g. 9-month length, Protecting Access to Medicare Act, prevent 24 percent cut medicare physician payment. HR 4302 (PL-113-93), Protecting Access to Medicare Act, Medicare physician payment rate extended for one year. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1871, SGR Repeal and Medicare Beneficiary Access, Medicare Physician Payment rate and implementation of alternative payment models. S. 2000, Repeal Medicare Sustainable Growth Rate, Repeal SGR. Positive update and higher rate for primary care, Medicare Physician Payment rate and implementation of alternative payment models. S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. S. 2157, the commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, AHRQ 15th anniversary, Promoting primary care research. No Bill Number, President's FY 2015 budget, Federal spending priorities to support workforce, research; Supporting budget proposals for primary care research, education and training programs. No Bill Number, Coalition meetings to promote Medicaid parity payment, extend Medicaid parity for primary care. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, Medicare physician payment reform of the SGR, 2014 Proposed Medicare physician fee schedule. No Bill Number, Conversion to ICD-10, Urged HHS to delay and test ICD-10 before requiring it. No Bill Number, Medicare Part-D Formulary, Opposing regulation that would eliminate protected statuys of antidepressants and antipsychotics in the Part D formulary. No Bill Number, Notification of Lapsed Payment of Health Insurance Premiums, Revising policy to have insurance plans notify physicians that a patient has not paid one month's permium. No Bill Number, Primary Care Incentive Payment Revision, Monitoring MedPAC recommendation to make PCIP a capitated payment. No Bill Number, Extend Medicare/medicare parity for primary care services, Extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015. No Bill Number, Coalition meetings to promote Medicaid parity payment, Extend Medicaid parity for primary care. No Bill Number, Hearing of Energy and Commerce Subcommittee on Oversight and Investigations, Implementation of the Affordable Care Act's health Insurance Marketplaces. No Bill Number, Rural Physician Workforce, Access to care in rural areas; increased family physician workforce.

HR 3547, Appropriations for Labor HHS, Education and Related Agencies, AAFP budget priorities, Title VII Sec 747, Federal spending priorities to support workforce. HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill; Urge W&M offives to discuss during March 2014 budget hearing. HR 1281, Newborn Screening Saves Lives Reauthorization Act. S. 1978, Increasing Primary Care Access Act, Family physician workforce. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the teaching Health Centers Graduate Medicare Education program. No Bill Number, Rural physician workforce, Access to care in rural areas; Increased famaily physician workforce. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, President's FY 2015 budget, Federal spending priorities to support workforce, research. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, HRSA budget, Promoting health care access and increase physician workforce.

Client expense: $629,961 · Firm income: Not reported

HR 487, Primary Care Workforce Access Improvement Act; pilot test alternatives to GME payment in order to increase primary care physician training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 3230, Veterans Access, Choice and Accountablility Act; Support for allowing family physicians to provide health care to veterans paid for by the VHA. HR 4015, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. HR 4292, The Underserved Veterans Access to Healthcare Act; support for primary care residency positionsin VA health system. HR 5481, Health IT-FLEX-IT Act, Urge leadership and member offices to support bill during lame duck session- bill would shorten 2015 reporting period for meaningful use. HR 5498, Primary Care Physician Reentry Act, Facillitate reentry into practice for primary care physicians. HJ Res. 124, the Continuing Resolution; Support for continued funding for Health Professions Grants and other discretionary programs for primary care. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1932, the Better Care at Lower Cost Act, Support for chronic care management. S. 1978, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program; Increasing Primary Care access Act, Family physician workforce. S. 2000, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 2229, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 2694, Medicaid Parity for Primary care, including S. 2694, advocate for extension of parity which expires at the end of 2014; urge Senators to co-sponsor S. 2694. S. 2728, Extending and increasing funding for grants to teaching health centers. No Bill Number, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME; Support for primary care residency slots in non-hospital; settings. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities. No Bill Number, Patient Safety and Primary Care Research, Patient safety and primary care research at AHRQ. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Advisory Committee on Training in Primary Care Medicine and Dentistry, Federal spending on primary care medicine training grants. No Bill Number, Increased funding for Title 747, Federal spending on primary care medicine training grants. No Bill Number, Joining Forces Mental Health Convening, mental health care for returning service members & families. No Bill Number, Increased funding for AHRQ, Federal spending on patient safety primary care research. No Bill Number, Ebola Public Health Threat, Family Physician Kent Brantly testified at Senate hearing. No Bill Number, Medicare EHR incentive payments, Concerns over attestation process. No Bill Number, Infection Advisory, Nominated a FP to a panel. No Bill Number, Medicare physician payment, Comments of 2015 proposed payments. No Bill Number, Medicaid advisory panel, Nomiated FPs to MACPAC. No Bill Number, Physician relative value units, Comments on proposed review of RVUs by CMS. No Bill Number, Tobacco delivery devices, Urged FDA to assert authority. No Bill Number, Continuing Medical Education, Urged CMS to not change Open Payment CME policy. No Bill Number, Food Safety Modernization Act, Support for regulation to prevent food-borne illnesses. No Bill Number, Adult Pneumococcal Vaccine, Support for Medicare payment to administer PCV13.No Bill Number, Health Insurance Marketplace Issues & Provider Involvement with Patient Enrollment, Network adequacy,Patient Enrollment in Marketplaces. No Bill Number, E-Cigarettes, Support of FDA proposed rule giving the agency authority to regulate e-cigarettes. No Bill Number, Medicare Physician Payment Proposed Rule; Support for payment strategies that recognize primary care and care coordination.

HR 487, Primary Care Workforce Access Improvement Act, pilot test alternatives to GME payment to increase PCP training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 5481, Health IT-FLEX-IT Act, Urge leadership and member offices to support bill during lame duck session- bill would shorten 2015 reporting period for meaningful use. HR 4015, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1932, the Better Care at Lower Cost Act, Support for chronic care management. S. 2000, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2694, Medicaid Parity for Primary care, including S. 2694, advocate for extension of parity which expires at the end of 2014; urge Senators to co-sponsor S. 2694; Ensuring Access to Primary Care for Women and Children Act, Prevent Medicaid primary care physician pay cut; Support for extension of this provision to pay primary care physicians for primary care services; extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015; Seek House companion legislation. S. 2728, Community-based Medical Education Act of 2014, Medicare GME reform and THC GME reauthorization; Extending and increasing funding for grants to teaching health centers. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME. No Bill Number, Medicare Graduate Medical Education, Medicare GME Reform. No Bill Number, Medicare EHR incentive payments, Concerns over attestation process. No Bill Number, Medicare physician payment, Comments of 2015 proposed payments. No Bill Number, Medicare Physician Payment Proposed Rule; Support for payment strategies that recognize primary care and care coordination. No Bill Number, Graduate Medical Education, Support for primary care residency slots in non-hospital settings. No Bill Number, Adult Pneumococcal Vaccine, Support for Medicare payment to administer PCV13. No Bill Number, Pharmaceutical Companies' Payments to Physicians; Support for keeping payments for continuing education excluded from reporting. No Bill Number, Meaningful Use of Health Information Technology Requirements, Support for 90-day EHR reporting period for 2015. No Bill Number, Narrow Networks, Support for restricting health plans' ability to disassociate with primary care physicians. No Bill Number, Repeal SGR, Positive update and higher rate for primary care.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill; GME reform increase primary care physician training; pilot test alternatives to GME payment in order to increase primary care physician training.HR 3230, Veterans Access, Choice and Accountablility Act; Support for allowing family physicians to provide health care to veterans paid for by the VHA. HR 3528, National All Schedules Prescription Electronic Reporting Reauthorization Act; prevent opiod abuse, encourage adequate pain management. HR 4292, The Underserved Veterans Access to Healthcare Act; support for primary care residency positionsin VA health system. HR 5498, Primary Care Physician Reentry Act, Facillitate reentry into practice for primary care physicians. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1978, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education; Increasing Primary Care Access; family physician workforce. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2529, National All Schedules Prescription Electronic Reporting Reauthorization Act; prevent opiod abuse, encourage adequate pain management. S. 2728, Community-Based Medical Education Act; Support for extension of Teaching Health Centers; extending and funding for grants to teaching health centers. HJ Res. 124, the Continuing Resolution; Support for continued funding for Health Professions Grants and other discretionary programs for primary care. No Bill Number, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME; Support for primary care residency slots in non-hospital settings. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Medicare Graduate Medical Education, Medicare GME reform No Bill Number, Increased funding for Title 747, Federal spending on primary care medicine training grants. No Bill Number, Advisory Committee on Training in Primary Care Medicine and Dentistry, Federal spending on primary care medicine training grants. No Bill Number, Pharmaceutical Companies' Payments to Physicians; Support for keeping payments for continuing education excluded from reporting.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill; urge W&M offices to discuss during March 2014 budget hearing, GME reform increase primary care physician training, pilot test alternatives to GME payment to increase PCP training.HR 2305, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2810, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2867, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2969, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 3306, Telehealth Enhancement Act, Defining the home base for telehealth reimbursement to incluse family medicine offices. HR 4015, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4209, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4302, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. HR 4418, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4543, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1123, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1184, Treat and Reduce Obesity Act, Seeking House and Senate cosponsors for obesity legislation. S. 1318, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1769, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1871, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program, increase family physician workforce. S. 2000, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. S. 2110, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. S. 2122, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2415, Seeking House and Senate cosponsors for obesity legislation. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014. No Bill Number, Medicare Primary Care Incentive Payment, Urge Ways and Means members to discuss at annual MedPac hearing. No Bill Number, Telemedicine,advocate for AAFP policies to be included in a potential bipartisan telehealth bill. No Bill Number, Medicare Site Neutral Payments; advocate for AAFP policies to be included in conncection with MedPac hearing. No Bill Number, Extend Medicare/medicare parity for primary care services, Extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015. No Bill Number, Direct Primary Care, Primary care model of retainer-based practice. No Bill Number, Medicare physician payment reform of the SGR, 2014 converstion factor. No Bill Number, Repeal SGR, Positive update and higher rate for primary care.No Bill Number, Site-neutral payment for medical services, Support site-neutral payment by CMS for medical services. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act, provider and open enrollment issues.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill, GME reform increase primary care physician training, Pilot test alternatives to GME payment in order to increase primary care physician training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 3306, Telehealth Enhancement Act, Defining the home base for telehealth reimbursement to incluse family medicine offices. HR 4299, Improving Regulatory Transparency for New Medical Therapies Act, Improving DEA's process for scheduling new drugs approved by the FDA. HR 4709, Ensuring Patient Access and Effective Drug Enforcement Act, Allowing supply chain stakeholders for prescription drugs to collaborate. HR 4810, VA Health Reform, Improve access for veterans to primary care services, both inside the VA and outside. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1994, TRICARE Moms Improvement Act, Supporting TRICARE payment for breastfeeding support and supplies and counseling. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program, increase family physician workforce. S. 2229, Expanding Primary Care Access and Workforce Act, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC. S. 2450, VA Health Reform, Improve access for veterans to primary care services, both inside the VA and outside No Bill Number, Extend Medicare/Medicare parity for primary care services, Extend Medicaid pay increase to Medicare levels beyond 2015. H. Con. Res. 96, House Budget Resolution, Protecting access to primary care in Medicaid. No Bill Number, Children's Health, Advocate for reauthorization of CHIP and children's mental health issues via coalition group meetings. No Bill Number, First Friday & Health Care Provider Meetings, Provider outreach groups for ACA, provider, and open enrollment issues. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014; advocate for members to mention at E&C hearing. No Bill Number, Medicare Primary Care Incentive Payment, Urge Ways and Means members to discuss at annual MedPac hearing. No Bill Number, Telemedicine,advocate for AAFP policies to be included in a potential bipartisan telehealth bill. No Bill Number, Teaching Health Centers, advocate for introduction of bipartisan bill to reauthorize the program. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Veterans Health Care, advocate for inclusion of policies in final bill that allow family doctors to easily contract with the VA; advocate for primary-care GME slots in the VA. No Bill Number, FDA regulation of tobacco products, Oppose any limits or amendments that would limit FDA ability to regulate cigars. No Bill Number, E-Cigarettes impact on public health; Support FDA regulation of e-cigarettes, still urging FDA to regulate all tobacco. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities.No Bill Number, Rural workforce, Comments on FQHC final rule. No Bill Number, VA committee on Woman Veterans, Nominated to FPs to the VA committee. No Bill Number, HHS Appropriations, Funding for health professions training grants, AHRQ research, and National Health Service Corps (NHSC). No Bill Number, Enhanced Medicaid payment for primary care, Extending the enhanced Medicaid payment for primary care. No Bill Number, Site-neutral payment for medical services, Support site-neutral payment by CMS for medical services. No Bill Number, White House's Health Kids and Save Sports Concussion Summit, Providing family physicians with latest information about sports concussions. No Bill Number, Veterans Health Administration, Allowing community physicians to charge VA for services to Vets. No Bill Number, Direct Primary Care, Primary care model of retainer-based practice. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, 2014 conversion factor. No Bill Number, Graduate Medical Education, comments on 2015 proposed IPPS. No Bill Number, Health IT, asking CMS to delay MU2. No Bill Number, Non-discrimination, Advocate for correct use of non-discrimination clause in Affordable Care Act. No Bill Number, Extend Medicare/Medicare parity for primary services, extend Medicaid pay increase to Medicare levels beyond 2015. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act, provider and open enrollment issues.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill; GME reform increase primary care physician training; pilot test alternatives to GME payment in order to increase primary care physician training.S. 1978, Increasing Primary Care Access Act, Family physician workforce. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the teaching Health Centers Graduate Medicare Education program. S. 2229, Expanding Primary Care Access and Workforce Act, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Prescription Drug Abuse, Prevent opiod abuse, encourage adequate pain management via coalition group meetings. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities. No Bill Number, Teaching Health Centers, advocate for introduction of bipartisan bill to reauthorize the program.

Client expense: $627,558 · Firm income: Not reported

H.R.5464 and draft Senate legislation, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015, Title II H.R. 83, P.L.113-235, Consolidated and Further Continuing Appropriations Act, 2015, Division G, Title II Issues: Support funding for NIH, Title VII and Title VIII health professions and nursing education programs, Agency for Healthcare Research and Quality (AHRQ), National Health Service Corps (NHSC), Children's Hospitals Graduate Medical Education program (CHGME), HRSA, biodefense and public health preparedness programs, and CDC's National Healthcare Safety Network (NHSN) and the Prevention Epicenters Program. Maintain NIH salary cap at Executive Level II. Encourage the highest possible allocation for the Labor-HHS Subcommittee. Support emergency supplemental funding to prepare and respond to Ebola and to reimburse for Ebola Virus Disease treatment. H.R. 4486 and draft Senate legislation, Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2015, Title II H.R. 83, P.L.113-235, Consolidated and Further Continuing Appropriations Act, 2015, Division I, Title II President's Budget, FY 2016 Issues: Support funding for Veterans Affairs medical research, research infrastructure, and health care. Issue: Funding for Community Health Centers and the NHSC. Debt in Health Education Loan programs (DebtHELP) bill (draft) Issues: Expand National Health Service Corps State Loan Repayment program, align Department of Education and Health Resources and Services Administration student loan programs. S. 577, Resident Physician Shortage Reduction Act of 2013 H.R. 1180, Resident Physician Shortage Reduction Act of 2013 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. H.R. 1201, Training Tomorrow's Doctors Today Act Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments and increase Graduate Medical Education (GME) accountability and transparency. H.R. 487, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act, Sections 5503 and 5506 Issue: Redistribution of residency positions. Issue: Implementation of and funding for Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the Affordable Care Act. H.R. 2810/S. 1871, SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013. Issues: Support repeal of Medicare's sustainable growth rate (SGR) formula; Medicare physician payment reform. Issue: Support the use of animals in medical research. S. 2553/H.R. 4994, Improving Medicare Post-Acute Care Transformation Act of 2014 Issue: Standardization of post-acute care assessment data for quality, payment, and discharge planning. Issue: Promote interprofessional education and training of the health care workforce. Issue: Support funding for the National Healthcare Workforce Commission. Issue: Implementation of 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: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose discretionary spending cuts through sequestration, including NIH, Titles VII and VIII health professions and nursing education programs, and other science programs. Issue: Support primary care workforce development S. 1759, Teaching Health Center Reauthorization Act Issue: Legislation to reauthorize the Teaching Health Center Program and payments. Issue: Draft legislation on pain education in undergraduate and graduate medical education. H.R.548/S. 1152, The Building A Health Care Workforce for the Future Act Issue: Support bill to increase scholarship opportunities for medical students and encourage primary care workforce development. H.R. 5294, Health Equity and Accountability Act of 2014 Issue: Support bill to improve health equity. Issue: Oppose inclusion of Medicare add-on payments in Hospital-Acquired Condition (HAC) program. H.R. 3698, Two Midnight Rule Delay Act of 2013 S. 2082, Two Midnight Rule Coordination and Improvement Act of 2014 Issue: Support delay of enforcement of new CMS inpatient criteria (e.g., "Two-Midnight" rule) in FY 2014 Inpatient Prospective Payment System (IPPS) final rule. Issue: Support Medicare GME per Resident Amount and cap trigger technical corrections and administrative relief. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmissions Program Act. S. 2501, Hospital Readmission Accuracy and Accountability Act. Issue: Support inclusion of socioeconomic status as part of hospital readmissions program, including support for adoption of National Quality Forum (NQF) recommendations. Issue: Educating health professionals regarding prescription drug abuse and appropriate use of antibiotics. Issue: Support report language and efforts of HHS agencies to support efforts of urban-based institutions to improve health equity. Support use of holistic review in admissions. Issue: Support ACA consumer outreach and enrollment efforts. Issue: Implementation of the 340B drug discount program. Issue: Oppose Medicare payment reductions as offsets for non-Medicare spending. Issue: Support preservation of funding for the Primary Care Residency Expansion program. S. 2229, Expanding Primary Care Access and Workforce Act Issue: Offer comments on primary care workforce legislation. H.R. 5411, Trafficking Awareness Training for Health Care Act of 2014 Issue: Medical education curricula content pertaining to human trafficking. S. 2658/H.R.5580, Accelerating Biomedical Research Act Issue: To increase discretionary spending cap to increase funding for the National Institutes of Health (NIH). S. 2450, Veterans' Access to Care through Choice, Accountability, and Transparency Act H.R. 4810, Veteran Access to Care Act Issue: Addressing VA backlogs by increasing care for veterans provided by non-VA facilities. S. 2115, American Cures Act H.R. 4384, America HEALS ACT Issue: Support establishment of a fund to provide an expanded and sustained investment in biomedical research. H.R. 4879, Research for All Act Issues: Support inclusion of male and female cells, tissues and animals in basic biomedical research. Support update of NIH guidelines to increase participation of women in clinical trials. Issue: FDA regulation of Laboratory Developed Tests (LDTs) S. 2728, Community Based Medical Education Act of 2014 Issue: Oppose reduction of Medicare GME/IME payments S. 2645, The Recovery Enhancement for Addiction Treatment (TREAT) Act Issue: Support legislation to increase access to care for patients addicted to opioids S. 2942, The Infectious Disease Hospitals Hubs Act Issue: Support legislation to establish a network of hospitals in preparing for and responding to infectious diseases. Issue: Support nomination of Dr. Vivek Murthy as U.S. Surgeon General Draft Hospital Improvements for Payment (HIP) Act of 2014 Issues: Support repeal of CMS Two-Midnights Rule, extending RAC audit moratorium for short stays, and permanent bundle program. Issue: Oppose further delays in the implementation of the ICD-10 system Submitted comments to: U.S. Census Bureau on the American Community Survey CMS on the Hospital Acquired Conditions Reduction Program (HAC)s technical expert panel (TEP)s report regarding the scoring of hospitals in the HAC program CMS on final rule regarding definition of uninsured for purposes of Medicaid DSH limits HHS on revisions to the safe harbors under the anti-kickback statute and civil monetary penalty rules (gainsharing, etc.) FDA on strategies for increasing patient involvement in regulatory processes. White House Ebola Response Coordinator offering to work with federal and state officials to prepare and respond to Ebola cases. NIH in response to an RFI related to the development of grant program to help facilitate the transition from training to independence. NIH on the consideration of sex as a biological variable in biomedical research The Patient-Centered Outcomes Research Institute (PCORI) on the proposed process for peer review and public release of its primary research finding. DEA on delaying the Disposal of Controlled Substances Final Rule.

S. 577, Resident Physician Shortage Reduction Act of 2013 H.R. 1180, Resident Physician Shortage Reduction of 2013. 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. H.R. 1201, Training Tomorrow's Doctors Today Act Issues: 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. Issue: Implementation and funding for 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: Support Medicare physician payment reform. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. H.R. 487, Primary Care Workforce Access Improvement Act. Issue: Residency training in community-based settings. Issue: Primary Care Workforce Development. President's Budget, FY 2015 Issue: Oppose proposed reductions in Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments; oppose use of Medicare GME funding for creation of new GME grant program. Issue: Oppose inclusion of Medicare add-on payments in Hospital-Acquired Condition (HAC) program. Issue: Oppose Medicare payment reductions as offsets for non-Medicare spending. S. 2082, Two Midnight Rule Coordination and Improvement Act of 2014 H.R. 3698, Two Midnight Rule Delay Act of 2013 Issue: Support delay of Enforcement of new Centers for Medicare and Medicaid Services inpatient criteria (e.g., "Two-Midnight" rule) in FY 2014 Inpatient Prospective Payment System (IPPS) final rule. Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmissions Program Act S. 2501, Hospital Readmission Accuracy and Accountability Act Issue: Support inclusion of socioeconomic status as part of hospital readmissions program. H.R. 2810/S. 1871, SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013 Issues: Support repeal of Medicares Sustainable Growth Rate (SGR) formula; Medicare physician payment reform. Issue: Draft legislation on educating health professionals regarding appropriate use of antibiotics. Issue: Support report language and efforts of HHS agencies to support efforts of urban-based institutions to improve health equity. Issue: Implementation of the 340B drug discount program. H.R. 4302, Protecting Access to Medicare Act of 2013. Issues: Support Medicare physician payment relief and extended delay of Medicare's "two-midnights" policy for hospital admissions; support the addition of GME language related to establishing Medicare caps and PRA; support delayed implementation of Medicaid DSH cuts. H.R. 4282, Creating Access to Residency Education Act of 2014 Issue: Create CMS grant program for new residency programs. Issue: Support inclusion of socioeconomic status as part of hospital readmissions program including support for adoption of National Quality Forum (NQF) recommendations. Issue: Support Medicaid expansion advocacy efforts. Issue: Draft legislation on pain education in undergraduate and graduate medical education. S. 2229, Expanding Primary Care Access and Workforce Act Issue: Offer comments on primary care workforce legislation. H.R. 4942, Underserved Veterans Access to Health Care Act Issue: Increasing funding for VA GME and Medicare GME. S. 2553/H.R. 4994, Improving Medicare Post-Acute Care Transformation Act of 2014. Issue: Standardization of post-acute care assessment data for quality, payment, and discharge planning. S. 2728, Community Based Medical Education Act of 2014 Issue: Oppose reduction of Medicare GME/IME payments. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the ACA. Draft Hospital Improvements for Payment (HIP) Act of 2014 Issues: Support repeal of CMS Two-Midnights Rule, extending RAC audit moratorium for short stays, and permanent bundle program. Issue: Oppose further delays in the implementation of the ICD-10 system Submitted comments to: Centers for Medicare & Medicaid Services (CMS) on the Hospital Acquired Conditions Reduction Program (HAC)s technical expert panel (TEP)s report regarding the scoring of hospitals in the HAC program. Centers for Medicare & Medicaid Services (CMS) on final rule regarding definition of uninsured for purposes of Medicaid DSH limits The Department of Health and Human Services (HHS) on revisions to the safe harbors under the anti-kickback statute and civil monetary penalty rules (gainsharing, etc.)

Monitor legislative activity related to health funding; graduate medical education funding; H.R. 487 - Primary Care Workforce Access Improvement Act; HR 1180 - Resident Physician Shortage Reduction Act; HR 1201 Training Tomorrow's Doctors Today Act; S. 577 - Resident Physician Shortage Reduction Act;

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation expanding the GME program: H.R. 1201, S. 577, H.R. 1180, H.R. 297, and H.R. 487.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Graduate Medical Education Affordable Care Act Primary Care Graduate Medical Education Pilot Program- H.R. 487 Training Tomorrow's Doctor's Today Act- H.R. 1201 Resident Physician Shortage Reduction Act of 2013- S.577 Teaching Health Centers Reauthorization Bill- S. 1759 Primary Care Exception Under Teaching Physician Regulation Building a Health Care Workforce for the Future Act- S. 1152 Expanding Primary Care Access and Workforce Act- S. 2229 Community-Based Medical Education Act of 2014- S. 2728 Increasing Primary Care Access Act- S. 1798

Client expense: $58,981 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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, Veterans Affairs, Dept of (VA)

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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 enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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.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 nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2015 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission, the Centers for Medicare and Medicaid Services, Operations and Management of Exchanges; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. 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. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201, The Training Tomorrow's Doctors Today Act, S. 577, the Resident Physician Shortage Reduction Act of 2013, H.R. 487, the Primary Care Workforce Access and Improvement Act of 2013, and legislation to permanently reauthorize the Conrad State 30 J-1 visa waiver program through S. 616, the Conrad State 30 and Physician Access Act.Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers. Advance Care Planning: Urged the Centers for Medicare & Medicaid Services to adopt the American Medical Associations new Current Procedural Terminology Codes for advance care planning.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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 enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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.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 nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2015 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission, the Centers for Medicare and Medicaid Services, Operations and Management of Exchanges; Expressed concern to House and Senate leadership over the expiration, at the end of FY2015, of dedicated funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers. 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. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201, The Training Tomorrow's Doctors Today Act, S. 577, the Resident Physician Shortage Reduction Act of 2013, H.R. 487, the Primary Care Workforce Access and Improvement Act of 2013, and legislation to permanently reauthorize the Conrad State 30 J-1 visa waiver program through S. 616, the Conrad State 30 and Physician Access Act.Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers. Advance Care Planning: Urged the Centers for Medicare & Medicaid Services to adopt the American Medical Associations new Current Procedural Terminology Codes for advance care planning.

Monitor legislative activity related to health funding; graduate medical education funding; H.R. 487 - Primary Care Workforce Access Improvement Act; HR 1180 - Resident Physician Shortage Reduction Act; HR 1201 Training Tomorrow's Doctors Today Act; S. 577 - Resident Physician Shortage Reduction Act;

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Legislation expanding the GME program: H.R. 1201, S. 577, H.R. 1180, H.R. 297, and H.R. 487.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Draft House and Senate Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015, Title II H.R.5464, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015, Title IIIssues: Support funding for National Institutes of Health (NIH), Title VII and Title VIII health professions and nursing education programs, Agency for Healthcare Research and Quality (AHRQ), National Health Service Corps (NHSC), Children's Hospitals Graduate Medical Education program (CHGME), Health Resources and Services Administration (HRSA), biodefense and public health preparedness programs, and CDC's National Healthcare Safety Network (NHSN) and the Prevention Epicenters Program. Maintain NIH salary cap at Executive Level II. Encourage the highest possible allocation for the Labor-HHS Subcommittee. H.R. 4486 and draft Senate, Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2015, Title II President's Budget, FY 2016 Issues: Support funding for Veterans Affairs medical research, research infrastructure, and health care. Issue: Funding for Community Health Centers and the National Health Service Corps. Debt in Health Education Loan programs (Debt HELP) bill (draft) Issues: Expand National Health Service Corps State Loan Repayment program, align Department of Education and Health Resources and Services Administration student loan programs. S. 577, Resident Physician Shortage Reduction Act of 2013 H.R. 1180, Resident Physician Shortage Reduction Act of 2013 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. H.R. 1201, Training Tomorrow's Doctors Today Act Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments and increase Graduate Medical Education (GME) accountability and transparency. P.L. 111-148, Patient Protection and Affordable Care Act, Title V Issue: Reauthorizing National Health Service Corps Fund. H.R. 487, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act, Sections 5503 and 5506 Issue: Redistribution of residency positions. Issue: Implementation of and funding for Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the Affordable Care Act. H.R. 2810/S. 1871, SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013. Issues: Support repeal of Medicare's sustainable growth rate (SGR) formula; Medicare physician payment reform. Issue: Support the use of animals in medical research. S. 2553/H.R. 4994, Improving Medicare Post-Acute Care Transformation Act of 2014 Issue: Standardization of post-acute care assessment data for quality, payment, and discharge planning. Issue: Promote interprofessional education and training of the health care workforce. Issue: Support funding for the National Healthcare Workforce Commission.Issue: Implementation of 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: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose discretionary spending cuts through sequestration, including NIH, Titles VII and VIII health professions and nursing education programs, and other science programs. Issue: Support primary care workforce development S. 1759, Teaching Health Center Reauthorization Act Issue: Legislation to reauthorize the Teaching Health Center Program and payments. Issue: Draft legislation on pain education in undergraduate and graduate medical education. H.R.548/S. 1152, The Building A Health Care Workforce for the Future Act Issue: Support bill to increase scholarship opportunities for medical students and encourage primary care workforce development. H.R. 5294, Health Equity and Accountability Act of 2014 Issue: Support bill to improve health equity. Issue: Oppose implementation of Hospital-Acquired Condition (HAC) program and inclusion of Medicare add-on payments in HAC reduction program and penalties. H.R. 3698, Two Midnight Rule Delay Act of 2013 S. 2082, Two Midnight Rule Coordination and Improvement Act of 2014 Issue: Support delay of enforcement of new Centers for Medicare and Medicaid Services (CMS) inpatient criteria (e.g., "Two-Midnight" rule) in FY 2014 Inpatient Prospective Payment System (IPPS) final rule. Issue: Support Medicare Graduate Medical Education (GME) per Resident Amount and cap trigger technical corrections and administrative relief. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmissions Program Act. S. 2501, Hospital Readmission Accuracy and Accountability Act. Issue: Support inclusion of socioeconomic status as part of hospital readmissions program, including support for adoption of National Quality Forum (NQF) recommendations. President's Budget, FY 2015 Issues: Oppose proposed reductions in Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments; Oppose use of Medicare GME funding for creation of new GME grant program; oppose elimination of Children's Hospitals GME program. Issue: Legislation on educating health professionals regarding appropriate use of antibiotics. H.R. 4427, Enrich Act Draft Senate legislation Issue: Educating health professionals on nutrition.Issue: Support report language and efforts of HHS agencies to support efforts of urban-based institutions to improve health equity. Support use of holistic review in admissions. Issue: Support ACA consumer outreach and enrollment efforts. Issue: Implementation of the 340B drug discount program. Issue: Oppose Medicare payment reductions as offsets for non-Medicare spending. Issue: Support preservation of funding for the Primary Care Residency Expansion program. S. 2229, Expanding Primary Care Access and Workforce Act Issue: Offer comments on primary care workforce legislation. H.R. 5411, Trafficking Awareness Training for Health Care Act of 2014 Issue: Medical education curricula content pertaining to human trafficking. S. 2658/H.R.5580, Accelerating Biomedical Research Act Issue: To increase discretionary spending cap to increase funding for the National Institutes of Health (NIH). H.R. 4942, Underserved Veterans Access to Health Care Act Issue: Support increasing funding for VA GME and Medicare GME. S. 2450, Veterans' Access to Care through Choice, Accountability, and Transparency Act H.R. 4810, Veteran Access to Care Act Issue: Addressing VA backlogs by increasing care for veterans provided by non-VA facilities. S. 2115, American Cures Act H.R. 4384, America HEALS ACT Issue: Support establishment of a fund to provide an expanded and sustained investment in biomedical research. H.R. 4879, Research for All Act Issues: Support inclusion of male and female cells, tissues and animals in basic biomedical research. Support update of National Institutes of Health (NIH) guidelines to increase participation of women in clinical trials. Issue: FDA regulation of laboratory-derived tests S. 2728, Community Based Medical Education Act of 2014 Issue: Oppose reduction of Medicare GME/IME payments S. 2645, The Recovery Enhancement for Addiction Treatment (TREAT) Act Issue: Support legislation to increase access to care for patients addicted to opioids Submitted comments to: the Food and Drug Administration responding to draft guidance entitled Informed Consent Information Sheet: Guidance for IRBs, Clinical Investigators, and Sponsors. Centers for Medicare and Medicaid Services (CMS) on the CY 2015 Physician Fee Schedule Proposed Rule. Centers for Medicare and Medicaid Services (CMS) on the CY 2015 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. Centers for Medicare and Medicaid Services (CMS) in support of additional transparency and comment opportunity in the valuation of physician and other healthcare professional services. the Centers for Medicare and Medicaid Services (CMS) to express concern of the delays and complications in the Open Payments Review and Dispute Process.the Departments of Health and Human Services, Labor, and Treasury regarding standards for the use of reference-based pricing structures. Centers for Medicare and Medicaid Services (CMS) on Modifications to the Medicare and Medicaid Electronic Health Record Incentive Programs for 2014 and Revisions to the Certified EHR Technology Definition Proposed Rule. National Quality Forum on its Draft Report: Priority Setting for Performance Measurement: Addressing Performance Measure Gaps for the Health Workforce.

S. 577, Resident Physician Shortage Reduction Act of 2013 H.R. 1180, Resident Physician Shortage Reduction of 2013. 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.H.R. 1201, Training Tomorrow's Doctors Today Act Issues: 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. Issue: Implementation and funding for 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: Support Medicare physician payment reform. Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. H.R. 487, Primary Care Workforce Access Improvement Act. Issue: Residency training in community-based settings. Issue: Primary Care Workforce Development. President's Budget, FY 2015 Issue: Oppose proposed reductions in Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments; oppose use of Medicare GME funding for creation of new GME grant program. Issue: Oppose implementation of Hospital-Acquired Condition (HAC) program and inclusion of Medicare add-on payments in HAC reduction program and penalties. Issue: Oppose Medicare payment reductions as offsets for non-Medicare spending. S. 2082, Two Midnight Rule Coordination and Improvement Act of 2014 H.R. 3698, Two Midnight Rule Delay Act of 2013 Issue: Support delay of Enforcement of new Centers for Medicare and Medicaid Services inpatient criteria (e.g., "Two-Midnight" rule) in FY 2014 Inpatient Prospective Payment System (IPPS) final rule. Issue: Support expanding AAMC member participation in CMMI's state innovation group activities. Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. H.R. 4188, Establishing Beneficiary Equity in the Hospital Readmissions Program Act S. 2501, Hospital Readmission Accuracy and Accountability Act Issue: Support inclusion of socioeconomic status as part of hospital readmissions program. H.R. 2810/S. 1871, SGR Repeal and Medicare Beneficiary Access Improvement Act of 2013 Issues: Support repeal of Medicares Sustainable Growth Rate (SGR) formula; Medicare physician payment reform. Issue: Draft legislation on educating health professionals regarding appropriate use of antibiotics. Issue: Support report language and efforts of HHS agencies to support efforts of urban-based institutions to improve health equity. Issue: Implementation of the 340B drug discount program.H.R. 4302, Protecting Access to Medicare Act of 2013. Issues: Support Medicare physician payment relief and extended delay of Medicare's "two-midnights" policy for hospital admissions; support the addition of GME language related to establishing Medicare caps and PRA; support delayed implementation of Medicaid DSH cuts. H.R. 4282, Creating Access to Residency Education Act of 2014 Issue: Create CMS grant program for new residency programs. Issue: Support inclusion of socioeconomic status as part of hospital readmissions program including support for adoption of National Quality Forum (NQF) recommendations. Issue: Support Medicaid expansion advocacy efforts. Issue: Draft legislation on pain education in undergraduate and graduate medical education. S. 2229, Expanding Primary Case Access and Workforce Act Issue: Offer comments on primary care workforce legislation. H.R. 4942, Underserved Veterans Access to Health Care Act Issue: Increasing funding for VA GME and Medicare GME. S. 2553/H.R. 4994, Improving Medicare Post-Acute Care Transformation Act of 2014. Issue: Standardization of post-acute care assessment data for quality, payment, and discharge planning. S. 2728, Community Based Medical Education Act of 2014 Issue: Oppose reduction of Medicare GME/IME payments. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the ACA. Submitted comments to: Centers for Medicare and Medicaid Services (CMS) on the CY 2015 Physician Fee Schedule Proposed Rule. Centers for Medicare and Medicaid Services (CMS) on the CY 2015 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs. Centers for Medicare and Medicaid Services (CMS) in support of additional transparency and comment opportunity in the valuation of physician and other healthcare professional services. the Centers for Medicare and Medicaid Services (CMS) to express concern of the delays and complications in the Open Payments Review and Dispute Process.

Graduate Medical Education Affordable Care Act Primary Care Graduate Medical Education Pilot Program- H.R. 487 Training Tomorrow's Doctor's Today Act- H.R. 1201 Resident Physician Shortage Reduction Act of 2013- S.577 Teaching Health Centers Reauthorization Bill- S. 1759 Primary Care Exception Under Teaching Physician Regulation Building a Health Care Workforce for the Future Act- S. 1152 Expanding Primary Care Access and Workforce Act- S. 2229 Community-Based Medical Education Act of 2014- S. 2728 Increasing Primary Care Access Act- S. 1798

Client expense: $49,920 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), 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

HR 487, Primary Care Workforce Access Improvement Act, pilot test alternatives to GME payment to increase PCP training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 5481, Health IT-FLEX-IT Act, Urge leadership and member offices to support bill during lame duck session- bill would shorten 2015 reporting period for meaningful use. HR 4015, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1932, the Better Care at Lower Cost Act, Support for chronic care management. S. 2000, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2694, Medicaid Parity for Primary care, including S. 2694, advocate for extension of parity which expires at the end of 2014; urge Senators to co-sponsor S. 2694; Ensuring Access to Primary Care for Women and Children Act, Prevent Medicaid primary care physician pay cut; Support for extension of this provision to pay primary care physicians for primary care services; extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015; Seek House companion legislation. S. 2728, Community-based Medical Education Act of 2014, Medicare GME reform and THC GME reauthorization; Extending and increasing funding for grants to teaching health centers. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME. No Bill Number, Medicare Graduate Medical Education, Medicare GME Reform. No Bill Number, Medicare EHR incentive payments, Concerns over attestation process. No Bill Number, Medicare physician payment, Comments of 2015 proposed payments. No Bill Number, Medicare Physician Payment Proposed Rule; Support for payment strategies that recognize primary care and care coordination. No Bill Number, Graduate Medical Education, Support for primary care residency slots in non-hospital settings. No Bill Number, Adult Pneumococcal Vaccine, Support for Medicare payment to administer PCV13. No Bill Number, Pharmaceutical Companies' Payments to Physicians; Support for keeping payments for continuing education excluded from reporting. No Bill Number, Meaningful Use of Health Information Technology Requirements, Support for 90-day EHR reporting period for 2015. No Bill Number, Narrow Networks, Support for restricting health plans' ability to disassociate with primary care physicians. No Bill Number, Repeal SGR, Positive update and higher rate for primary care.

HR 487, Primary Care Workforce Access Improvement Act; pilot test alternatives to GME payment in order to increase primary care physician training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 3230, Veterans Access, Choice and Accountablility Act; Support for allowing family physicians to provide health care to veterans paid for by the VHA. HR 4015, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. HR 4292, The Underserved Veterans Access to Healthcare Act; support for primary care residency positionsin VA health system. HR 5481, Health IT-FLEX-IT Act, Urge leadership and member offices to support bill during lame duck session- bill would shorten 2015 reporting period for meaningful use. HR 5498, Primary Care Physician Reentry Act, Facillitate reentry into practice for primary care physicians. HJ Res. 124, the Continuing Resolution; Support for continued funding for Health Professions Grants and other discretionary programs for primary care. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1932, the Better Care at Lower Cost Act, Support for chronic care management. S. 1978, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program; Increasing Primary Care access Act, Family physician workforce. S. 2000, SGR Repeal and Medicarte Provider Payment Modernization Act, Support repeal of SGR and replacement with value-based payment systems. S. 2229, Reauthorizing Teaching Health Center GME Program, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 2694, Medicaid Parity for Primary care, including S. 2694, advocate for extension of parity which expires at the end of 2014; urge Senators to co-sponsor S. 2694. S. 2728, Extending and increasing funding for grants to teaching health centers. No Bill Number, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME; Support for primary care residency slots in non-hospital; settings. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities. No Bill Number, Patient Safety and Primary Care Research, Patient safety and primary care research at AHRQ. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Advisory Committee on Training in Primary Care Medicine and Dentistry, Federal spending on primary care medicine training grants. No Bill Number, Increased funding for Title 747, Federal spending on primary care medicine training grants. No Bill Number, Joining Forces Mental Health Convening, mental health care for returning service members & families. No Bill Number, Increased funding for AHRQ, Federal spending on patient safety primary care research. No Bill Number, Ebola Public Health Threat, Family Physician Kent Brantly testified at Senate hearing. No Bill Number, Medicare EHR incentive payments, Concerns over attestation process. No Bill Number, Infection Advisory, Nominated a FP to a panel. No Bill Number, Medicare physician payment, Comments of 2015 proposed payments. No Bill Number, Medicaid advisory panel, Nomiated FPs to MACPAC. No Bill Number, Physician relative value units, Comments on proposed review of RVUs by CMS. No Bill Number, Tobacco delivery devices, Urged FDA to assert authority. No Bill Number, Continuing Medical Education, Urged CMS to not change Open Payment CME policy. No Bill Number, Food Safety Modernization Act, Support for regulation to prevent food-borne illnesses. No Bill Number, Adult Pneumococcal Vaccine, Support for Medicare payment to administer PCV13.No Bill Number, Health Insurance Marketplace Issues & Provider Involvement with Patient Enrollment, Network adequacy,Patient Enrollment in Marketplaces. No Bill Number, E-Cigarettes, Support of FDA proposed rule giving the agency authority to regulate e-cigarettes. No Bill Number, Medicare Physician Payment Proposed Rule; Support for payment strategies that recognize primary care and care coordination.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill; GME reform increase primary care physician training; pilot test alternatives to GME payment in order to increase primary care physician training.HR 3230, Veterans Access, Choice and Accountablility Act; Support for allowing family physicians to provide health care to veterans paid for by the VHA. HR 3528, National All Schedules Prescription Electronic Reporting Reauthorization Act; prevent opiod abuse, encourage adequate pain management. HR 4292, The Underserved Veterans Access to Healthcare Act; support for primary care residency positionsin VA health system. HR 5498, Primary Care Physician Reentry Act, Facillitate reentry into practice for primary care physicians. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1978, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education; Increasing Primary Care Access; family physician workforce. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2529, National All Schedules Prescription Electronic Reporting Reauthorization Act; prevent opiod abuse, encourage adequate pain management. S. 2728, Community-Based Medical Education Act; Support for extension of Teaching Health Centers; extending and funding for grants to teaching health centers. HJ Res. 124, the Continuing Resolution; Support for continued funding for Health Professions Grants and other discretionary programs for primary care. No Bill Number, Graduate Medical Education, Explain and advocate for AAFP's newly released policy proposals on GME; Support for primary care residency slots in non-hospital settings. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Medicare Graduate Medical Education, Medicare GME reform No Bill Number, Increased funding for Title 747, Federal spending on primary care medicine training grants. No Bill Number, Advisory Committee on Training in Primary Care Medicine and Dentistry, Federal spending on primary care medicine training grants. No Bill Number, Pharmaceutical Companies' Payments to Physicians; Support for keeping payments for continuing education excluded from reporting.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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 enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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.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 nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2015 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission, the Centers for Medicare and Medicaid Services, Operations and Management of Exchanges. 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. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201, The Training Tomorrow's Doctors Today Act, S. 577, the Resident Physician Shortage Reduction Act of 2013, H.R. 487, the Primary Care Workforce Access and Improvement Act of 2013, and legislation to permanently reauthorize the Conrad State 30 J-1 visa waiver program through S. 616, the Conrad State 30 and Physician Access Act.Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through S. 2694, the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers. Medicares Prior Authorization Process for Certain Durable Medical Equipment: Commented in July 2014 to CMS on the proposed rule requesting clarification and making recommendations on changes to the Medicare benefit structure to ensure that any proposed changes not increase the administrative burden on physicians or other health care professionals.

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; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; 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). 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 enactment of the Medicare Physician Payment Innovation Act (H.R. 574), as introduced in Feb. 2013 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. 574 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.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 nearly 25 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2014; Advocated for H.R. 2810, the SGR Repeal and Medicare Beneficiary Access Act of 2013, which would repeal the SGR and transition to a new value-based payment and delivery system; Advocated for H.R. 4015/S.2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, legislation introduced on Feb. 6, 2014 to repeal the SGR and transition to a new value-based payment and delivery system. 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; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). FY2015 Appropriations: 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 funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps, Community Health Centers Fund, National Health Care Workforce Commission, the Centers for Medicare and Medicaid Services, Operations and Management of Exchanges. 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. Advocated to federal health agencies that wellness programs must not be used as a means to discriminate against the sick and vulnerable. Wellness programs must be developed to encourage prevention and improve health rather than penalize those who are medically unable to meet wellness program goals; Advocated that employers and health plans should fund programs proven to be effective in reducing obesity, stopping smoking, deterring alcohol abuse, and promoting wellness and providing coverage or subsidies for individuals to participate in such programs. 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 to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. 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; Advocated for the Saving Lives, Saving Costs Act (H.R. 4106), which establishes a framework for health care liability lawsuits to undergo review by independent medical review panels if health care professionals (practicing physicians or their agents or employees) allege adherence to applicable clinical practice guidelines in the provision of health care goods or services. Workforce: Advocated for H.R. 1201, The Training Tomorrow's Doctors Today Act, S. 577, the Resident Physician Shortage Reduction Act of 2013, H.R. 487, the Primary Care Workforce Access and Improvement Act of 2013, and legislation to permanently reauthorize the Conrad State 30 J-1 visa waiver program through S. 616, the Conrad State 30 and Physician Access Act.Medicaid Pay Parity: Advocated for extending for at least two more years, beyond 2014, the Medicaid primary care payment increase, as enacted under the Affordable Care Act, which has only recently been implemented in a majority of states, and (2) including physicians practicing obstetrics and gynecology as qualified specialties, subject to the current eligibility requirement that at least 60 percent of their Medicaid billings are the primary care services as defined by the authorizing legislation, for the purposes of qualifying for the Medicaid primary care increases; Advocated for at least a two-year extension of the Medicaid payment parity provision beyond its 2014 expiration date, namely through S. 2694, the Ensuring Access to Primary Care for Women & Children Act. Tobacco Regulation: Expressed strong opposition to House appropriators to any amendment that would exempt any type of cigar from regulation under the Family Smoking Prevention and Tobacco Control Act, P.L. 111-31, or would impede the rulemaking process the Food and Drug Administration (FDA) has initiated to determine the appropriate level of oversight for tobacco products not currently regulated by the agency; the FDA should retain the authority to regulate all tobacco products, including cigars, and should be permitted to use a science-based process for determining those regulations; Advocated in Aug. 2014 for the Child Nicotine Poisoning Prevention Act of 2014, which gives the U.S. Consumer Product Safety Commission the authority to require the use of child-proof packaging on liquid nicotine containers sold to consumers. Medicares Prior Authorization Process for Certain Durable Medical Equipment: Commented in July 2014 to CMS on the proposed rule requesting clarification and making recommendations on changes to the Medicare benefit structure to ensure that any proposed changes not increase the administrative burden on physicians or other health care professionals.

Yet to be introduced, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015: health care information technology funding and projects. Executive agency action: promote regional electronic health record demonstration and telehealth. H.R. 487, Primary Care Workforce Access Improvement Act of 2013 (entire bill). Executive agency action: support for inpatient rehabilitation care. S. 596, Fostering Independence Through Technology Act of 2013 (entire bill).

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

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

Monitor legislative activity related to health funding; graduate medical education funding; H.R. 487 - Primary Care Workforce Access Improvement Act; HR 1180 - Resident Physician Shortage Reduction Act; HR 1201 Training Tomorrow's Doctors Today Act; S. 577 - Resident Physician Shortage Reduction Act;

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill. HR 1281, Newborn Screening Saves lives Reauthorization Act, Supporting parent and provider newborn screening education programs and research at NIH.HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill. HR 1281, Newborn Screening Saves lives Reauthorization Act, Supporting parent and provider newborn screening education programs and research at NIH. HR 2642, 5-year Farm Bill, FDA, tobacco regulation and nutrition programs. HR 2810, Repeal of Medicare SGR formula, Repeal of SGR to be replaced by a positive payment update and higher rate for primary care, Medicare Physician Payment rate and implementation of alternative payment models. HR 3547, Promoting Teaching Health Centers, AHRQ, Title VII primary care grants and NHSC appropriations, AAFP budget priorities, Title VII Sec 747, Teaching Health Center grants, NHSC, AHRQ. HR 4302 (SGR patch legislation), Advocate for inclusion of policies that benefit primary care, e.g. 9-month length. HR 4302, Protecting Access to Medicare Act, Medicare physician payment rate extended for one year. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1871, SGR Repeal and Medicare Beneficiary Access, Medicare Physician Payment rate and implementation of alternative payment models. S. 1978, Increasing Primary Care Access Act, Family physician workforce. S. 2000, SGR repeal and Medicare provider Payment Modernization, Medicare Physician Payment rate and implementation of alternative payment models. S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. S. 2157, the commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014; advocate for members to mention at E&C hearing. No Bill Number, Telemedicine, educate staff on AAFP's view of telemedicine policies. No Bill Number, Rural physician workforce, Access to care in rural areas; Increased family physician workforce. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, AHRQ 15th anniversary, Promoting primary care research. No Bill Number, President's FY 2015 budget, Federal spending prioritiesto support workforce, research. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, Coalition meetings to promote Medicaid parity payment, extend Medicaid parity for primary care. No Bill Number, HRSA budget, promoting health care access and increase physician workforce. No Bill Number, Medicare physician payment reform of the SGR, 2014 conversion factor. No Bill Number, E-Cigarettes, Urge FDA to regulate all tobacco products. No Bill Number, Graduate Medical Education, Nominate FP's to Council on GME. No Bill Number, Health insurance marketplaces, concerns with 90-day grace period. No Bill Number, Anti-competitive aspects of healthcare, FTC hearing and request for comments on professional regulations role. No Bill Number, Part D formularies, Opposed CMS changes to Part D formularies. No Bill Number, Nomination of Dr. Vivek Murthy for Surgeon General. No Bill Number, Tobacco Cessation Programs, Asking HHS to clearly define a comprehensive tobacco cessation benefit in health insurance coverage. No Bill Number, FY 2015 Federal Budget Proposal, Supporting budget proposals for primary care research, education and training programs.No Bill Number, Competition in Health Care Industries, Recommending state oversight in health care scope of practice and FTC oversight of hospital and insurance consolidations. No Bill Number, Notification of Lapsed Payment of Health Care Insurance Premiums, Revising policy to have insurance plans notify physicians that a patient has not paid on-month's premium. No Bill Number, Primary Care Incentive Payment Revision, Monitoring MedPac recommendation to make PCIP a capitated payment. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act issues. No Bill Number, FTC Healthcare Competition Workshop, Scope of Practice issues. No Bill Number, Hearing of Energy and Commerce Subcommittee on Oversight and Investigations, Implementation of the Affordable Care Act's Health Insurance Marketplaces. No Bill Number, Energy and Commerce Health Subcommittee Hearing on drug shortages, reducing the incidence of local and regional shortage of drugs. No Bill Number, Energy and Commerce Subcommittee on Oversight and Investigations - Hearing on Counterfeit drugs. No Bill Number, Energy and Commerce Subcommittee on Commerce, Manufacturing and Trade - hearing on Sports safety.

HR 3547, Appropriations for Labor HHS, Education and Related Agencies, AAFP budget priorities, Title VII Sec 747, Federal spending priorities to support workforce. HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill; Urge W&M offives to discuss during March 2014 budget hearing.HR 1281, Newborn Screening Saves Lives Reauthorization Act. S. 1978, Increasing Primary Care Access Act, Family physician workforce. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the teaching Health Centers Graduate Medicare Education program. No Bill Number, Rural physician workforce, Access to care in rural areas; Increased famaily physician workforce. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, President's FY 2015 budget, Federal spending priorities to support workforce, research. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, HRSA budget, Promoting health care access and increase physician workforce.

Client expense: $629,961 · Firm income: Not reported

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate to sponsor bill; urge W&M offices to discuss during March 2014 budget hearing.HR 2810, Repeal of Medicare SGR formula, Repeal of SGR to be replaced by a positive payment update and higher rate for primary care. Medicare Patient Access and Quality Improvement Act, Medicare Physician paymnent rate and implementation of alternative payment models. HR 4302 (SGR patch legislation), Advocate for inclusion of policies that benefit primary care, e.g. 9-month length, Protecting Access to Medicare Act, prevent 24 percent cut medicare physician payment. HR 4302 (PL-113-93), Protecting Access to Medicare Act, Medicare physician payment rate extended for one year. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1871, SGR Repeal and Medicare Beneficiary Access, Medicare Physician Payment rate and implementation of alternative payment models. S. 2000, Repeal Medicare Sustainable Growth Rate, Repeal SGR. Positive update and higher rate for primary care, Medicare Physician Payment rate and implementation of alternative payment models. S. 2110, Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. S. 2157, the commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act, Medicare Physician Payment rate and implementation of alternative payment models. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014. No Bill Number, Call for an end to sequestration, End accross-the-board cuts to Medicare, NHSC, CHC, primary care research and training. No Bill Number, AHRQ 15th anniversary, Promoting primary care research. No Bill Number, President's FY 2015 budget, Federal spending priorities to support workforce, research; Supporting budget proposals for primary care research, education and training programs. No Bill Number, Coalition meetings to promote Medicaid parity payment, extend Medicaid parity for primary care. No Bill Number, AHEC Title VII section 751 program, Family physician workforce. No Bill Number, Medicare physician payment reform of the SGR, 2014 Proposed Medicare physician fee schedule. No Bill Number, Conversion to ICD-10, Urged HHS to delay and test ICD-10 before requiring it. No Bill Number, Medicare Part-D Formulary, Opposing regulation that would eliminate protected statuys of antidepressants and antipsychotics in the Part D formulary. No Bill Number, Notification of Lapsed Payment of Health Insurance Premiums, Revising policy to have insurance plans notify physicians that a patient has not paid one month's permium. No Bill Number, Primary Care Incentive Payment Revision, Monitoring MedPAC recommendation to make PCIP a capitated payment. No Bill Number, Extend Medicare/medicare parity for primary care services, Extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015. No Bill Number, Coalition meetings to promote Medicaid parity payment, Extend Medicaid parity for primary care. No Bill Number, Hearing of Energy and Commerce Subcommittee on Oversight and Investigations, Implementation of the Affordable Care Act's health Insurance Marketplaces. No Bill Number, Rural Physician Workforce, Access to care in rural areas; increased family physician workforce.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill; GME reform increase primary care physician training; pilot test alternatives to GME payment in order to increase primary care physician training.S. 1978, Increasing Primary Care Access Act, Family physician workforce. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the teaching Health Centers Graduate Medicare Education program. S. 2229, Expanding Primary Care Access and Workforce Act, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Prescription Drug Abuse, Prevent opiod abuse, encourage adequate pain management via coalition group meetings. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities. No Bill Number, Teaching Health Centers, advocate for introduction of bipartisan bill to reauthorize the program.

Client expense: $1,257,519 · Firm income: Not reported

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill, GME reform increase primary care physician training, Pilot test alternatives to GME payment in order to increase primary care physician training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 3306, Telehealth Enhancement Act, Defining the home base for telehealth reimbursement to incluse family medicine offices. HR 4299, Improving Regulatory Transparency for New Medical Therapies Act, Improving DEA's process for scheduling new drugs approved by the FDA. HR 4709, Ensuring Patient Access and Effective Drug Enforcement Act, Allowing supply chain stakeholders for prescription drugs to collaborate. HR 4810, VA Health Reform, Improve access for veterans to primary care services, both inside the VA and outside. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1994, TRICARE Moms Improvement Act, Supporting TRICARE payment for breastfeeding support and supplies and counseling. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program, increase family physician workforce. S. 2229, Expanding Primary Care Access and Workforce Act, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC. S. 2450, VA Health Reform, Improve access for veterans to primary care services, both inside the VA and outside No Bill Number, Extend Medicare/Medicare parity for primary care services, Extend Medicaid pay increase to Medicare levels beyond 2015. H. Con. Res. 96, House Budget Resolution, Protecting access to primary care in Medicaid. No Bill Number, Children's Health, Advocate for reauthorization of CHIP and children's mental health issues via coalition group meetings. No Bill Number, First Friday & Health Care Provider Meetings, Provider outreach groups for ACA, provider, and open enrollment issues. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014; advocate for members to mention at E&C hearing. No Bill Number, Medicare Primary Care Incentive Payment, Urge Ways and Means members to discuss at annual MedPac hearing. No Bill Number, Telemedicine,advocate for AAFP policies to be included in a potential bipartisan telehealth bill. No Bill Number, Teaching Health Centers, advocate for introduction of bipartisan bill to reauthorize the program. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Veterans Health Care, advocate for inclusion of policies in final bill that allow family doctors to easily contract with the VA; advocate for primary-care GME slots in the VA. No Bill Number, FDA regulation of tobacco products, Oppose any limits or amendments that would limit FDA ability to regulate cigars. No Bill Number, E-Cigarettes impact on public health; Support FDA regulation of e-cigarettes, still urging FDA to regulate all tobacco. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities.No Bill Number, Rural workforce, Comments on FQHC final rule. No Bill Number, VA committee on Woman Veterans, Nominated to FPs to the VA committee. No Bill Number, HHS Appropriations, Funding for health professions training grants, AHRQ research, and National Health Service Corps (NHSC). No Bill Number, Enhanced Medicaid payment for primary care, Extending the enhanced Medicaid payment for primary care. No Bill Number, Site-neutral payment for medical services, Support site-neutral payment by CMS for medical services. No Bill Number, White House's Health Kids and Save Sports Concussion Summit, Providing family physicians with latest information about sports concussions. No Bill Number, Veterans Health Administration, Allowing community physicians to charge VA for services to Vets. No Bill Number, Direct Primary Care, Primary care model of retainer-based practice. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, 2014 conversion factor. No Bill Number, Graduate Medical Education, comments on 2015 proposed IPPS. No Bill Number, Health IT, asking CMS to delay MU2. No Bill Number, Non-discrimination, Advocate for correct use of non-discrimination clause in Affordable Care Act. No Bill Number, Extend Medicare/Medicare parity for primary services, extend Medicaid pay increase to Medicare levels beyond 2015. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act, provider and open enrollment issues.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill; urge W&M offices to discuss during March 2014 budget hearing, GME reform increase primary care physician training, pilot test alternatives to GME payment to increase PCP training.HR 2305, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2810, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2867, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 2969, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 3306, Telehealth Enhancement Act, Defining the home base for telehealth reimbursement to incluse family medicine offices. HR 4015, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4209, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4302, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. HR 4418, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. HR 4543, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1123, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1184, Treat and Reduce Obesity Act, Seeking House and Senate cosponsors for obesity legislation. S. 1318, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1759, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 1769, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1871, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program, increase family physician workforce. S. 2000, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. S. 2110, Medicare Payment Reform, Repeal SGR. Positive update and higher rate for primary care. S. 2122, Medicare Payment Reform, Repeal SGR, Positive update and higher rate for primary care. S. 2229, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education. S. 2415, Seeking House and Senate cosponsors for obesity legislation. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014. No Bill Number, Medicare Primary Care Incentive Payment, Urge Ways and Means members to discuss at annual MedPac hearing. No Bill Number, Telemedicine,advocate for AAFP policies to be included in a potential bipartisan telehealth bill. No Bill Number, Medicare Site Neutral Payments; advocate for AAFP policies to be included in conncection with MedPac hearing. No Bill Number, Extend Medicare/medicare parity for primary care services, Extend increase in Medicaid payments for primary care services to Medicare levels beyond 2015. No Bill Number, Direct Primary Care, Primary care model of retainer-based practice. No Bill Number, Medicare physician payment reform of the SGR, 2014 converstion factor. No Bill Number, Repeal SGR, Positive update and higher rate for primary care.No Bill Number, Site-neutral payment for medical services, Support site-neutral payment by CMS for medical services. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act, provider and open enrollment issues.

HR 487, Primary Care Workforce Access Improvement Act, Urge House to cosponsor bill that would create GME pilot project to train primary care doctors, urge Senate offices to sponsor bill, GME reform increase primary care physician training, Pilot test alternatives to GME payment in order to increase primary care physician training.HR 2415, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. HR 3306, Telehealth Enhancement Act, Defining the home base for telehealth reimbursement to incluse family medicine offices. HR 4299, Improving Regulatory Transparency for New Medical Therapies Act, Improving DEA's process for scheduling new drugs approved by the FDA. HR 4709, Ensuring Patient Access and Effective Drug Enforcement Act, Allowing supply chain stakeholders for prescription drugs to collaborate. HR 4810, VA Health Reform, Improve access for veterans to primary care services, both inside the VA and outside. S. 1184, Treat and Reduce Obsity, Seeking House and Senate cosponsors for obesity legislation. S. 1759, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program. S. 1994, TRICARE Moms Improvement Act, Supporting TRICARE payment for breastfeeding support and supplies and counseling. S. 1978, Increasing Primary Care Access Act, Family physician workforce, Teaching Health Center Reauthorization Act, Reauthorize the Teaching Health Centers Graduate Medical Education program, increase family physician workforce. S. 2229, Expanding Primary Care Access and Workforce Act, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC, Reauthorizing Teaching Health Center GME program, Teaching Health Centers Graduate Medical Education, Reauthorizing Title VII primary care programs, Teaching Health Centers and the NHSC. S. 2450, VA Health Reform, Improve access for veterans to primary care services, both inside the VA and outside No Bill Number, Extend Medicare/Medicare parity for primary care services, Extend Medicaid pay increase to Medicare levels beyond 2015. H. Con. Res. 96, House Budget Resolution, Protecting access to primary care in Medicaid. No Bill Number, Children's Health, Advocate for reauthorization of CHIP and children's mental health issues via coalition group meetings. No Bill Number, First Friday & Health Care Provider Meetings, Provider outreach groups for ACA, provider, and open enrollment issues. No Bill Number, SGR Repeal and Replacement process, Advocate for SGR repeal and new physician payment system that pays for value and primary care. No Bill Number, Medicaid Primary Care Bonus, Advocate for extension of the Medicaid bonus which expires at the end of 2014; advocate for members to mention at E&C hearing. No Bill Number, Medicare Primary Care Incentive Payment, Urge Ways and Means members to discuss at annual MedPac hearing. No Bill Number, Telemedicine,advocate for AAFP policies to be included in a potential bipartisan telehealth bill. No Bill Number, Teaching Health Centers, advocate for introduction of bipartisan bill to reauthorize the program. No Bill Number, FY funding increses in AHRQ, Title VII 747, NHSC, Teaching Health Center planning grants, Federal spending priorities to support workforce, research. No Bill Number, Veterans Health Care, advocate for inclusion of policies in final bill that allow family doctors to easily contract with the VA; advocate for primary-care GME slots in the VA. No Bill Number, FDA regulation of tobacco products, Oppose any limits or amendments that would limit FDA ability to regulate cigars. No Bill Number, E-Cigarettes impact on public health; Support FDA regulation of e-cigarettes, still urging FDA to regulate all tobacco. No Bill Number, National Health Service Corps trust fund reauthorization, appropriation, NHSC provides scholarships & debt relief as well as physicians for underserved communities.No Bill Number, Rural workforce, Comments on FQHC final rule. No Bill Number, VA committee on Woman Veterans, Nominated to FPs to the VA committee. No Bill Number, HHS Appropriations, Funding for health professions training grants, AHRQ research, and National Health Service Corps (NHSC). No Bill Number, Enhanced Medicaid payment for primary care, Extending the enhanced Medicaid payment for primary care. No Bill Number, Site-neutral payment for medical services, Support site-neutral payment by CMS for medical services. No Bill Number, White House's Health Kids and Save Sports Concussion Summit, Providing family physicians with latest information about sports concussions. No Bill Number, Veterans Health Administration, Allowing community physicians to charge VA for services to Vets. No Bill Number, Direct Primary Care, Primary care model of retainer-based practice. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, 2014 conversion factor. No Bill Number, Graduate Medical Education, comments on 2015 proposed IPPS. No Bill Number, Health IT, asking CMS to delay MU2. No Bill Number, Non-discrimination, Advocate for correct use of non-discrimination clause in Affordable Care Act. No Bill Number, Extend Medicare/Medicare parity for primary services, extend Medicaid pay increase to Medicare levels beyond 2015. No Bill Number, First Fridays Meetings, Provider outreach group for Affordable Care Act, provider and open enrollment issues.