Fourth Quarter 2012 The Scope of Family Medicine A Publication of the Alabama Academy of Family Physicians • www.alabamafamilyphysicians.org

Making a Home: How Becoming a PCMH Transformed a Small Practice – And Why It Was Worth it PG 7 Medical Home Pilot Benefits Patients and Physicians to Alabama PG 10 2 The Scope of Family Medicine The Scope of Family Medicine Winter 2012

Officers Contents *Allen Perkins, MD, President From the President...... 5 *Tom Kincer, MD, President-Elect Drake Lavender, MD, VP Northwest (’14) Making a Home: How Becoming a PCMH Pamela Tuck, MD, VP Southeast (’15) Transformed a Small Practice – and Why It Was Worth It.....7 Jarod Spear, MD, VP Northeast (’16) Boyd Bailey, MD, VP Southwest (’13) Medicaid Reform Imminent...... 8 *Mike McBrearty, MD, Treasurer Chapter Secures Provider Meeting with Medicaid re: Jeffrey E. Arrington, Executive Vice President (*indicates member of the Executive Committee) January Payment Increase...... 8

Board of Directors “Payer of Last Resort” Rule Maximizes Taxpayer *Tonya Bradley, MD, Chair Dollars for Medicaid...... 9 Jerry Harrison, MD, At Large (’13) Julia Boothe, MD, At Large (’15) AAFP Contract Review Program for Residents...... 9 Pamela Tuck, MD, At Large (’14) Medical Home Pilot Program Benefits Patients Nelson Cook, MD, Calhoun County Branch Michael McBrearty, MD, Gulf Coast Branch and Physicians in Alabama...... 10 Lisa Columbia, MD, Jefferson County Branch 2012 Alabama Health Care Hall of Fame Inductees...... 11 Tracy Jacobs, MD, Resident Chapter President Fuller McCabe, Student Representative Congratulations!...... 11

Congressional District Reps Organizations Fight to Repeal Call for New Vacant – District 1 Payment Methods...... 12 Beverly Jordan, MD – District 2 Michael Goodlett, MD – District 3 UAB 2012 Rural Medicine Program Class...... 12 Laura Lee Adams, MD – District 4 UA Rural Medical Scholars Class 17...... 12 Kristy Crandell, MD – District 5 Albert Smith, MD – District 6 Save the Date!...... 13 Bob Grubbs, MD – District 7 Annual Meeting and Scientific Symposium...... 14 AAFP Delegates Melissa Behringer, MD (’14) Steve Furr, MD, (’13) Advertisers Alabama Department of Public Health, Epidemiology Division...... 6 AAFP Alternate Delegates Alabama Department of Public Health, Immunization Division...... 4 Tonya Bradley, MD (’14) Belk & Associates, Inc...... 6 Jerry Harrison, MD (’13) Children’s of Alabama...... 6 Scope Managing Editor Coastal Insurance Risk Retention Group, Inc...... 15 Jeffrey E. Arrington ECR Pharmaceuticals...... 9 Alabama Academy of Family Physicians Healthcare Workers’ Compensation Self-Insurance Fund...... 13 19 South Jackson Street ProAssurance Group...... 2 Montgomery, Alabama 36104 334-954-2570 The University of Alabama College of Community Health Sciences...... 16 Toll-free: 877-343-2237 Fax: 334-954-2573 [email protected] www.alabamafamilyphysicians.org Like us on Facebook!

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Published December 2012 • 2012/4 Published December 2012 necessarily reflect the policy of the Alabama Acad- emyAlabama of Family Academy Physicians. of Family Physicians 3 4 The Scope of Family Medicine FROM THE PRESIDENT

The Patient-Centered Home and Meaningful Use by Allen Perkins, MD

s I go to meetings and talk to family ing the health experience could lead to re- stick to determine if we get paid more. We A docs, everyone agrees on one thing … duced waste and better patient outcomes.2 purchased an electronic health record (Next- the job of the family physician has become As a physician with training in public health, Gen) that has sufficient bells and whistles to more difficult. Our “partialist” colleagues I can see how improving care delivery and help us achieve Meaningful Use. This was have been catered to for the last 10 years by reducing costs will allow us to more effec- in a large part because the government uses hospitals and insurance companies and are tively target resources. For example, better the Meaningful Use rules to determine if living the high life. We feel like we have been diabetes care has led to a reduction in ampu- the taxpayers should help us to foot the bill cast into the wilderness, saddled with increas- tations by 75 percent during the last 10 years, for the purchase. As the leader of a clinical ing responsibilities and decreasing margins. and we can do even better with better orga- practice that is striving to achieve both, I am The mandate to introduce the electronic nized, proactive care.3 Seen in this way, the aware that the rules are complex and require health record into the office setting, while Patient-Centered Medical Home becomes a a lot of effort to achieve compliance. I also well-intended (and actually at least partially way to better organize the hard work we do, see evidence that the rules are written to be funded), is seen as just another example of rendering it easier and allow us to demon- complimentary and by achieving both we government overreach. The movement to- strate accountability. Meaningful Use (the will ultimately improve our care delivery.4 ward Patient-Centered Medical Home-mod- measurement tool the government is using eled care is seen as merely putting a label on to determine how much money practices get There are many resources which demonstrate what we do anyway. for installing electronic health records) could the synergy between the two sets of require- be seen as a way to hold us accountable for ments. Going to the NCQA website (www. Although not a popular sentiment among the purchase of a piece of software necessary ncqa.org), the following “crosswalk” demon- physicians, I tend to be a contrarian in this to achieve PCMH designation. strates just how closely aligned the two sets of matter. As a taxpayer, I look at the waste that requirements are. To achieve Meaningful Use, occurs as my patients seek care in a disor- We have elected as a group to work to there are only two activities (reporting family ganized and uncoordinated fashion. I am achieve NCQA PCMH certification for our history as structured data and reporting data glad that at least someone is attempting to practice. It is in part because it will help us into a disease registry) that do not occur in the bring some order to this chaos and looking to deliver measurably better care. Mostly it is PCMH requirements. In short, by achieving for ways to pay us for providing the com- because Blue Cross of Alabama established one, we are able to achieve both. By achieving plex, coordinated care that reduces health NCQA certification as necessary to achieve both, we are going to deliver measurably bet- care costs.1 As a physician who practices as their highest level of quality for primary care ter care for our patients. Equally as important, part of a larger system, I see how improv- physicians and is using it as a measuring we will become eligible for additional money from our insurers and become eligible for ad- ditional money for our practice overhead. I encourage you to consider the same.

References 1. Starfield B, Macinko J, Shi L. Contribution of Pri- mary Care to Health Systems and Health. The Mil- bank Quarterly 83.3 (2005): 457-502. 2. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012;307:1513-1516. 3. Li Y, Burrows N, Gregg E, Albright A, Geiss L. Declining Rates of Hospitalization for Nontrau- matic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: U.S., 1988- 2008 Diabetes Care February 2012 35:273-277; doi:10.2337/dc11-1360. 4. Meyers D, Quinn M, Clancy C. Health Informa- tion Technology: Turning the Patient-Centered Medical Home From Concept to Reality. American Journal of Medical Quality 26.2 (2011): 154.

Alabama Academy of Family Physicians 5 Locum Tenens and Permanent Jobs for Physicians 1.888.892.4DRS

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6 The Scope of Family Medicine “It is our attitude at the beginning of a difficult task which, more than anything else, will affect its successful outcome.” — William James, American philosopher Making a Home: How Becoming a PCMH Transformed a Small Practice – and Why It Was Worth It

by Eugene Heslin, MD, Head Physician at Bridge Street Medical Group, a Six-Physician Family Practice in Saugerties, New York

f a small family practice tucked deep in Our experience shows that, with proper sup- ing a medical home taught us to effectively I the Hudson Valley of New York can make port, transformation is possible regardless manage an entire population of patients the transition to a patient-centered medical of practice size or type. We’re not part of an — not just the ones who walk through home, so can you. integrated health system or a large multispe- our doors in a given week or month. That cialty practice. We’re just rural family doc- enhances our efforts at disease preven- You could say we’re the classic small-town tors who turned our practice into a thriving tion and helps us better care for our pa- practice. We serve a rural community of medical home. tients with chronic conditions. about 18,000. I can head out of the front door of my office, walk about a half-mile, throw a Health IT support Satisfaction Across the Board rock and hit a cow. Our community is close- We could not have accomplished this with- Patients, as part of the team, have clearer — knit, and my practice serves entire families, out the intelligent use of EHRs. I know some and higher — expectations for the manage- from tiny babies to centenarians. If I see a practices see health IT as an obstacle — even ment of their health. They are more likely to 60-year-old patient in my office today, it’s a threat. But meaningful use of health IT is adhere to a regimen. That’s because it’s not likely I’m also caring for her husband, her inevitable. Moreover, health IT supports our regimen — it’s theirs’. Patient satisfaction sister, her daughter and her grandson. practice redesign. Ultimately, meaningful has improved. So has staff morale. use of health IT is about delivering appro- Despite our size and relative isolation, in priate, patient-centered care. Why have I We have created a friendly, competitive en- 2009, we decided to adopt the medical home embraced EHRs and other health IT tools? vironment, and we are working “smarter.” model. This wasn’t something mandated by Because of our patients. Because my practice We do more with less. Our staff members, a payer or the government. It arose from our wants to provide good family care. And we working at the top of their licenses, have passion for high-quality patient care. want the tools to do so. come together as a team that works collab- oratively to improve the practice. We became part of a collaborative effort Value Over Volume called the Hudson Valley Initiative (HVI). Because we have achieved medical home A Return on Investment HVI’s sponsoring organizations — Tacon- status, we are reimbursed for tasks that Don’t misunderstand: Transformation takes ic IPA, THINC and MedAllies — led 236 haven’t been traditionally covered, such as financial and sweat equity. Most of all, it physicians at 11 primary care practices at care management for chronically ill patients. takes time. You will encounter more hurdles 51 sites throughout the Hudson Valley to My fellow physicians and I can now pursue than you anticipate. We did, and we over- achieve NCQA Level 3 PPC-PCMH patient- the intellectual aspect of practicing medi- came them. So can you. centered medical home recognition in 2010. cine — not just the procedural. We are paid Hundreds more in the region have since fol- for the value we provide; it is reimbursement I’m not offering my practice as a blue- lowed in our footsteps. through achievement. print. The path we took to become a medical home won’t be the one you take. HVI’s philosophy reflects many of my own We now see fewer patients per day, and I can But Bridge Street does demonstrate how core beliefs: devote plenty of time to those I do see. This a small rural practice can accomplish • Health care should be patient-centered, co- enhances the quality of care. That’s not just PCMH transformation — gradually, ordinated and accessible my opinion: We can measure our quality, and thoughtfully and thoroughly, leaving no • Financial models used to pay for we’ve seen our quality indicators rise. patient or staff person behind. health care should result in lower cost and increased quality One way we’ve been able to provide value Today, my staff and fellow physicians are sat- • Health information technology should be is through population health management. isfied with their work. My patients are hap- used as a tool to improve patient care and We’ve always provided excellent care for pier, healthier and more engaged. I have no community health the patients who came to our office. Becom- doubts: It was worth the effort.

Alabama Academy of Family Physicians 7 Medicaid Medicaid Reform Imminent

on Williamson, MD, who is leading the Medicaid transition, As part of this process, chapter board members have also lent their D said that the YES vote on September 18 was much-needed experience and expertise to out-of-state consultants who have been and will buy time as the state explores ways to sustain the program contracted by the Alabama Hospital Association to assess the best for the long term. One happy change is that the Agency reversed options for our state. The findings of this analysis will likely feed provider payment cuts effective October 1. Now, state leaders are into the decision-making process of the commission. The commis- taking action to reform Alabama Medicaid like never before, fo- sion will be asked to recommend plans for reforming Medicaid to cused on three areas — financing, delivery and payment — in order the governor prior to the Legislature’s 2013 Regular Session, which to address rising costs in the program, increases over time in the begins in February. number of recipients, and impacts of the Affordable Care Act. “It is crucial for our voice to be heard in this process and working Two bodies are largely responsible for this reform effort: the Joint Leg- closely with other provider groups to make the best decisions for the islative Committee on Medicaid Policy, chaired by Rep. Greg Wren, patients and providers of Alabama will continue to be a priority of and the new Alabama Medicaid Advisory Commission, created by the Academy,” Chapter Executive Vice President Jeff Arrington said. Gov. Robert Bentley with the goal of reforming Medicaid by improv- ing financial stability and patient care. The chapter has had representa- Through this process, the consultants are exploring models from tion at numerous meetings of these bodies since the summer. other states to radically change how the program is funded, insti- tute more quality benchmarks, etc. Models under consideration “We are committed to increasing efficiency, eliminating fraud and include accountable care organizations and care coordination or- maintaining patient care,” Gov. Bentley said. “We believe we can de- ganizations, among others. The Medicaid Advisory Commission is liver higher-quality care while also controlling costs. The Alabama tasked with not only studying the issues laid out above but also with Medicaid Advisory Commission will help us accomplish this.” recommending a course of action for Gov. Bentley and state leaders to follow to make Medicaid financially sustainable and available to Chaired by Dr. Williamson, the commission will evaluate the Alabama deliver care to recipients going forward. Medicaid Agency’s financial structure and identify “ways to increase efficiency while also helping ensure the long-term sustainability of the “The Medicaid of the future will no longer be the Medicaid of the agency,” according to a release from the governor’s office. past,” Rep. Wren emphasized on numerous occasions.

Chapter Secures Provider Meeting with Medicaid re: January Payment Increase

Complicating the Medicaid funding equation further, certainly a bit The first step of this process will be checking providers for board of good news is the Affordable Care Act’s provision that will raise certification. If the Agency determines that a provider is not Medicaid payment to Medicare rates for primary care providers who board-certified by the applicable board, then Medicaid will review qualify beginning January 1 (the difference fully funded by the federal that physician’s claims data to attest that at least 60 percent of all government for two years). of the Medicaid services for which he or she bills are for E&M and vaccine administration codes specified for the payment increase. In an effort to assure that the payment increase for primary care pro- If a physician is still ineligible based on the “60 percent rule,” then viders takes effect in January, the chapter formally requested a meeting Medicaid will send him/her a letter and ask for self-attestation. with the medical directors at Medicaid. Chapter Executive Vice Presi- dent Jeff Arrington attended the meeting in early November, along Once average Medicare rates are determined, Medicaid will set up with representatives from the medical association and the Alabama a new reimbursement rate for the applicable codes, which will be chapter of the American Academy of Pediatrics. Medicaid reported paid per claim. One question for which we are seeking clarification that it is working on the required State Plan Amendment, relying on is the rule regarding physician extenders. The chapter will relay consultants to determine the average Medicare rates to match, and has more information on this as it is known. established its process for determination of physicians who will get the increase.

8 The Scope of Family Medicine “Payer of Last Resort” Rule Maximizes Taxpayer Dollars for Medicaid

any people are surprised to learn that eliminates the need for Medicaid to “pay M Alabama Medicaid recipients of- and chase” the claim. ten have private health insurance as well. To maximize state taxpayer dollars, the Alabama Procedure codes with modifier EP are used for Medicaid Agency’s Third Party Division is billing EPSDT screenings and are included in charged with the responsibility of ensuring the preventive pediatric services “federal ex- that Medicaid is the “payer of last resort.” ception” group. These codes include: Generally, this means that providers are re- sponsible for filing for reimbursement from Well Office Visit Preventive Procedure the primary insurance prior to billing Medic- Codes/Age aid, according to Keith Thompson, director of • 99391EP/Under Age 1 yr Alabama Medicaid’s Third Party Division. • 99392EP/Ages 1-4 yrs • 99393EP/Ages 5-11 yrs However, there are some federally required • 99394EP/Ages 12-17 yrs exceptions to this rule: 1. When the service is a preventive Dental Procedure Codes included in pediatric service “pay and chase” as a preventive pediatric 2. When the service is for prenatal care service include: provided outside of managed care • D0110 • D0120 Under these federal exceptions, Medicaid • D1110 is required to pay the claim if Medicaid is • D1120 billed first as the primary insurance. Med- • D1203 icaid then bills the other insurance plan • D1204 for reimbursement — a process known • D1330 as “pay and chase.” Please NOTE: The • D1351 federal rule is a Centers for Medicare and • D1510 Medicaid (CMS) requirement for Medic- • D1515 aid to pay if they are billed first. This is • D1520 Fourth Quarter 2012 The Scope not a federal requirement for the health • D1525 of Family Medicine A Publication of the Alabama Academy of Family Physicians • www.alabamafamilyphysicians.org care provider. Providers may choose to • D1550 bill preventive pediatric services (such as EPSDT screenings and preventive dental Providers with questions regarding benefit co- services) to the other insurance plan first ordination, filing procedures or other billing Making a Home: before billing Medicaid. Billing the oth- issues should contact the HP Provider Assis- How Becoming a PCMH Transformed a Small Practice – And Why It Was Worth it PG 7 er insurance plan first is acceptable and tance Center at 800-688-7989. Medical Home Pilot Benefits

Patients and Physicians to AlabamaPG 10

AAFP Contract Review To advertise in future issues of The Scope of Program for Residents Family Medicine, please contact Bob Sales at he Academy is pleased to announce that it has negotiated an arrangement with the 502.423.7272 or bsales@ T Sanders Law Firm, P.C. in Birmingham that will benefit residents and fellow mem- ipipub.com. bers of the Academy. Specifically, the Sanders Law Firm will review a draft employment agreement for any Academy member, discuss the draft employment agreement with the member and recommend changes where necessary for a flat fee of $500. Rich Sanders, the firm’s president, has spoken at the Summer and Mid-Winter meetings of AAFP since the late 1990s, and he has previously assisted Academy members with HIPAA and corporate www.ipipub.com compliance programs. If you have any questions about this contract review program, please call Rich Sanders at 205-930-4289 or e-mail him at [email protected].

Alabama Academy of Family Physicians 9 Medical Home Pilot Program Benefits Patients and Physicians in Alabama

here is an upcoming crisis in America The Medical Home Pilot Program internist. “A lot of these patients I’ve been T — an aging population and a health launched in September 2009 with 14 pilot seeing for 10 or 20 years. When we asked system whose costs are already out of con- clinics selected based on recommendations them to do this extensive history, I’d discov- trol. Combine that with a growing shortage from local medical societies, including the er something important I didn’t know about of primary care physicians and this creates Alabama Academy of Family Physicians. that patient … [and the patients] become a recipe for disaster. Alabamians are fortu- These 14 pilot clinics served diverse pa- more involved in their own care.” nate that at least one of the companies that tient populations and included five fam- pay their health care bills have taken notice ily practices, five internal medicine clinics Dr. Tamara McIntosh, a family physician at and is working to improve the environment and four pediatrician offices. Ohatchee Family Medical Clinic, explains for family physicians and other primary that the program benefitted her patients care physicians. All 14 practices, regardless of practice through “having [a] regular and continu- location or setting, earned recognition as ous source of health care, improved qual- Since participating in the Call to Action NCQA Patient-Centered Medical Homes ity of care delivered in a more organized Summit in Washington, D.C., in 2007, (PCMHs) by the end of the pilot program, manner, improved education of patients’ Blue Cross and Blue Shield of Alabama and the success did not stop with certifi- medical problems, improved patient experi- have looked for effective ways to facilitate cation. Pilot participants showed overall ences at their primary care office, greater ac- improved primary care. They began with improvement in patient satisfaction, clini- cess to needed services, increased focus on the Alabama Health Improvement Initia- cal outcomes and utilization metrics. Blue preventive services, potentially reduced cost tive Diabetes Program to improve diabetes Cross estimates that this improvement in of health care, (and) decreased ER visits and care. Within two years, the number of rec- performance resulted in 560 fewer hospital hospitalizations.” Dr. McIntosh says physi- ognized National Committee for Quality days and 580 fewer emergency room visits cians benefit from the program through “de- Assurance (NCQA) physicians in the state for an estimated savings of $1.9 million. veloping protocols for the office that make increased from one to 150, followed by a delivering health care more efficient, as well dramatic improvement in statewide qual- Both doctors and patients found value in as improving the quality of care.” When all ity metrics for diabetes care. Then, in early the patient-centered approach to care. An was said and done, after completing the re- 2009, the concept of a patient-centered example of this value was in the use of ex- quirements for the pilot program, Dr. McIn- medical home gained national momentum. tended history forms at Mobile Diagnostic tosh explains, “My greatest reward is having Blue Cross responded and, with input from Center. “[Despite] some resistance from pa- a more organized, standardized method of key stakeholders, designed and implement- tients and physicians, both found benefits,” providing care to patients.” ed the Medical Home Pilot Program. says Dr. Robert W. Israel, a primary care In the words of Blue Cross Medical Director Dr. Kathleen Bowen, “The pilot demonstrates that the concept is achievable throughout the state.” In addition, she says, “The data sup- port that care delivered in a Patient-Centered Medical Home improves patient satisfaction, health outcomes and access to care.”

Based on this success, Blue Cross is ex- panding the medical home approach with its Value-Based Payment Program. All primary care practices are encouraged to pursue NCQA PCMH Recognition through the 2012 Primary Care Value-Based Pay- ment Program, which provides doctors with incentives for meeting efficiency, quality and patient outcome criteria. The Academy is committed to helping provide resources to those interested in achieving this goal.

10 The Scope of Family Medicine 2012 Alabama Health Care Hall of Fame Inductees

Dr. Richard O. Rutland Jr., of Fayette, Alabama, and Dr. Steven Furr, of Jackson, Alabama, were 2012 inductees into the Alabama Health Care Hall of Fame.

Dr. Rutland, a past president of the Alabama Academy of Family Dr. Steven Furr, who has been serving the people in the Jackson Physicians who was instrumental during the 1960s in the develop- Alabama area for more than 30 years, was also inducted. In addi- ment of the College of Community Health Sciences (CCHS) at the tion to previously serving as a board member on the Alabama State University of Alabama, was inducted into the Alabama Health Care Board of Medical Examiners and the State Committee of Public Hall of Fame. While working with CCHS, he started a rural precep- Health, Dr. Furr has been president of the Medical Association of torship for medical students and family practice residents to spend the State of Alabama, the Alabama Academy of Family Physicians part of their training time in rural areas. He was appointed by the (AAFP) and the Alabama Medical Directors Association. Dr. Furr University of Alabama to assist in writing a history of the College of currently serves as an AAFP Executive Board Member and Del- Community Health Science in Tuscaloosa and Huntsville. egate for the Academy.

In 1981, Dr. Rutland was recognized as the Family Doctor of the Year He received his undergraduate degree from the University of South in the United States by Good Housekeeping magazine and the Amer- Alabama, as well as his medical degree. He is currently the vice chair ican Academy of Family Physicians. He was presented with a Cer- of the University of South Alabama Board of Trustees. tificate of Distinction for 50 years of medical practice by the Medical Association of the State of Alabama in 1999. He was also recognized Dr. Furr has also been a general and jurisdictional conference for 50 years of practice by the American Academy of Family Practice delegate for the past four quadrennia, as well as serving on the and his medical school alma mater, Tulane University. Southeastern Jurisdiction Episcopacy committee. He was one of three lay people chosen to give the Laity Address at the 2012 Dr. Rutland and his wife, Nancy Babb Rutland, have been married General Conference. for 54 years. They have four children: Richard O. Rutland III, MD, of Gadsden, Alabama; Craig D. Rutland, MD, of Nashville, Tennes- He is married to Lisa Sheffield Furr, who works in the public school see; Cindy McBrearty of Fairhope, Alabama (wife of Michael Mc- system as a teacher’s aide. Brearty, MD); and Melissa Cathey of Washington state.

Congratulations! Dr. John Meigs has been re-elected as the American Academy of Family Physicians Speaker of the Congress of Delegates.

Alabama Academy of Family Physicians 11 Organizations Fight to Repeal SGR, Call for New Payment Methods AAFP Joins With AARP, Four Others to Continue Working Toward SGR Resolution

he AAFP and several other groups have ing the past 10 years — T joined with the nation’s largest consum- reductions averted only er advocacy organization — the AARP — in by last-minute action by calling for a repeal of the sustainable growth Congress. Physicians rate (SGR) formula in favor of enactment of face a 26.5 percent re- a more equitable Medicare payment system. duction in the Medicare physician payment rate In a letter to House and Senate congressio- on Jan. 1 unless Con- nal leaders, the AAFP, the AARP, and four gress acts to block the other physician and Medicare advocacy cut. As the Jan. 1 dead- groups say that the need for payment reform line looms, the AAFP is overdue and that “addressing the current and other organizations flawed payment formula is a necessary and have stepped up pressure far-sighted course of action.” on Congress to repeal the SGR and to put in place “Congress has an opportunity to repeal new payment methods to the SGR — the first step toward enacting maintain Medicare access and encourage among people with Medicare about their a better payment system — by redirecting the delivery of high-quality care. ability to maintain access to their doctors.” money from the Overseas Contingency Operations fund the Pentagon says will “Congress has long recognized that the SGR The AAFP and the other organizations call never be spent,” states the letter, which also is a poor method for establishing payment on Congress to pass the longest possible is signed by the American College of Phy- rates for health care providers paid under SGR fix to allow Congress time to fix the sicians, the American Geriatrics Society, the Medicare physician fee schedule,” says situation permanently. But they also stress the Center for Medicare Advocacy and the the letter. “In each of the last 10 years, it has that it is important to keep Medicare afford- Medicare Rights Center. voted to override the cuts mandated under able for beneficiaries. the formula. These stopgap measures have The SGR has called for steep reductions in served to increase the size of future cuts, the Reprinted from AAFP News Now, November 26, 2012 the Medicare physician payment rate dur- cost of long-term reform and the insecurity

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12 The Scope of Family Medicine Alabama Academy of Family Physicians 13 "

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