SGIM HI M HILL D LL DAY ORIENT ENTATIO ION March 11, 2014 - PowerPoint PPT Presentation

SGIM HI M HILL D LL DAY ORIENT ENTATIO ION March 11, 2014

Agend nda  4:00 - 4:10 Introductions  4:10 - 4:30 Advocacy Guide-Erika Miller, CRD  4:30 - 4:50 Overview of issues  4:50 - 5:00 “Demo” Hill Day visit  5:00 - 5:15 Role playing visits  5:15 - 5:30 Questions and Wrap-Up

Over erview o of Adv dvoca cacy cy Issu Issues

The The SGI SGIM H Heal alth P h Pol olic icy Commi ommittee Promotes policies that improve patient care, strengthen education and training, and promote research in general internal medicine Chair-Mark Schwartz, Co-Chair Shawn Caudill • Education Subcommittee Chair, Bobby Baron • Research Subcommittee Chair, Gary Rosenthal • Clinical Practice Subcommittee Chair, Scott Joy • “Outreach” Subcommittee Chair, Cara Litvin

SGIM GIM’s ’s Ed Educat ucatio ion n Agenda da Graduate medical education (GME)  Expected shortage of 45,000 primary care physicians by 2020 as demand grows  GME funding largely provided by Medicare to support residency training, primarily at major teaching hospitals.  Two components:  Direct GME payments to cover Medicare’s share of the direct costs of training residents and fellows  Indirect medical education payments, which recognize the higher cost of treating patients in teaching hospitals.  GME payments help support trainees in all specialties and are paid directly to teaching hospitals, not to training programs.

SGIM GIM’s ’s Ed Educat ucatio ion n Agenda da GME Reform  SGIM is advocating that ALL ENTITIES that pay for health care contribute to GME funding.  GME payment structure should be transparent and exclusively for resident training.  GME programs must provide graduates with competencies to practice 21 st century medicine with funding tied to training outcomes.  CMS should provide incentives to institutions and training programs to promote the alignment of the practice patterns of their graduates with national and regional workforce needs.  Funding should be made available to foster GME innovations designed to positively impact the workforce.

SGIM GIM’s ’s Ed Educat ucatio ion n Agenda da Title VII  Title VII program of the US Public Health Service Act has supported training programs in family medicine, general internal medicine, general pediatrics, and geriatrics for decades  The Health Resources and Services Administration (HRSA) funds primary care training programs through Title VII training grants  Funding for Title VII programs has declined dramatically over the past 20 years

SGIM GIM’s ’s Ed Educat ucatio ion n Agenda da SGIM urges Congress to support HRSA programs to support primary care training, including:  $150 million for Training in Primary Care Medicine to support training and improved general competencies of primary care professionals through grants to hospitals, medical schools and other entities  $30 million for Centers of Excellence designed to increase the number of minority youth who pursue careers in the health professions  $30 million for the Health Careers Opportunity Program (HCOP) to provide students from disadvantaged backgrounds an opportunity to develop the skills needed to successfully compete, enter and graduate from health professions schools

SGIM GIM’s ’s R Res esear earch ch A Agend nda SGIM supports funding for: Agency for Healthcare Research and Quality 1. (AHRQ) • Mission is to improve safety, quality and effectiveness of healthcare for all Americans • SGIM supports strengthening of AHRQ with provision of no less than $375 million in base funding • SGIM urges increased funding for investigator- initiated research and the career development of young investigators

SGIM GIM’s ’s R Res esear earch ch Agenda da Patient Centered Outcomes Research Institute 2. (PCORI)  Created by ACA to fund research to enable patients and their physicians to make scientifically-based treatment decisions taking all factors into account  First awards issued 2012  Some legislation has threatened to repeal PCORI  SGIM urges congress to retain PCORI

SGIM GIM’s ’s R Res esear earch ch Agenda da National Institutes of Health (NIH) 3. 85% of funds appropriated are used for research  project grants in universities and research centers in every state NIH spending power has declined by 24% in the  past decade SGIM supports robust and sustainable NIH  budget that is no less than $32 billion Clinical and Translational Science Awards (CTSA)  are now based in the National Center to Advance Translational Science (NCATS) SGIM supports continued funding for these 62  CTSAs

SGIM GIM’s ’s R Res esear earch ch A Agend nda VA Medical and Prosthetics Research 4.  VA conducts important health services research  SGIM strongly supports a budget for research in the VA that is proportionate to the growing challenges of providing the best care to our veterans and that provides the evidence needed to improve the quality, cost, and access of VA healthcare.

SGIM GIM’s ’s C Clin inica ical P Pract ctice ice A Agenda da Definitions CMS- Centers for Medicare and Medicaid Services RVUs (Relative value units)- Measure of value used in the Medicare reimbursement formula for physicians services RBRVS (Resource-based relative value scale)- A payment system in which reimbursement is determined by the relative resource costs of the service. RVUs for work, practice expense and malpractice insurance are totaled and multiplied by a conversion factor and then adjusted by geographic area. RUC (Relative value update committee )- AMA committee which makes annual recommendations to CMS on physician work relative values (E&M/primary care providers under-represented)

SGIM GIM’s ’s C Clin inica ical P Pract ctice ice Agen enda da SGR (Sustainable growth rate) -  Established in 1997 to control the growth of physician reimbursement under Medicare  Complex formula that ties payment for physicians’ services to the rate of growth of the GDP  If rate of Medicare spending exceeds target SGR in a given year, payments for physicians’ services the following year are supposed to be reduced.  Since 2002, payments have exceeded the SGR. Every year, Congress prevents the cuts.  Estimated to cost $138 billion over ten years to eliminate the SGR.

SGR R Repeal a l and M Medicare re P Provi vider r Pa Payment nt M Moderniz izat atio ion A n Act  Bi-partisan, bicameral legislation to repeal SGR  Provides 0.5% update in fees until 2018  Establishes a merit-based payment incentive system which consolidates several Medicare quality programs with payment adjustment based on performance  Bonus for providers participating in alternative payment models and provision to provide care management payment for physicians participating in PCMH  Provision to identify and redistribute RVUs from potentially misvalued services.  Additional development of quality measures  CBO score of $138 billion over 10 years  Does not address flaws inherent in the RBRVS and maintains fee-for service payment system

SGIM GIM’s ’s C Clin inica ical P Pract ctice ice Agenda da SGIM is urging for Congress to:  Support the draft of a new set of evaluation and management codes for primary care physicians to better capture the complexity of work performed by primary care physicians  Support transparency in the RUC process  Pass SGR Repeal and Medicare Provider Payment Modernization Act

LE LET’S P PRACT CTIC ICE

Rol ole P Playin ying  Find a partner.  One person is the advocate, the other is the legislative representative.  Choose one area of advocacy (clinical practice, research, education).  Introduce yourself , provide brief background and make your ask!  Switch roles and play again.

Questions?