Representing the 13th Congressional District of Pennsylvania
| FOR IMMEDIATE RELEASE May 20, 2009 |
CONTACT: Rachel Magnuson, 202-225-6111 |
| U.S. Rep. Schwartz Announces Major Bill to Improve Health Care: Doctors, Nurses, and Other Health Care Providers Endorse Preserving Patient Access to Primary Care Act of 2009 | ||
“As we move toward creating a uniquely American solution in which all Americans have access to affordable, meaningful health coverage, it becomes clear that successful health care reform must include primary care reform,” said U.S. Rep. Allyson Schwartz.
“Primary care is at the core of America’s health care system, and a lynch-pin to care coordination and preventive health care, yet there are numerous challenges facing both primary care providers and patients. My plan, Preserving Patient Access to Primary Care Act of 2009, takes a multi-faceted approach to support our primary care workforce and enhance care coordination services,” added Schwartz.
Preserving Patient Access to Primary Care Act of 2009, H.R. 2350:
Establishes scholarship and loan repayment opportunities for primary care providers who serve in areas with critical shortages of primary care services.
Creates new residency positions for primary care and general surgery trainees, with more opportunities to train in ambulatory care setting — particularly community health centers.
Improves access to primary care for seniors by eliminating copayments for preventive care services in Medicare.
Increases Medicare reimbursements for primary care providers.
Establishes Medicare payments for care coordination services, and monthly payments to providers who serve as patient-centered medical homes
Groups speaking today to endorse the bill included: American College of Physicians; American Nurses Association; Association of American Medical Colleges; American Academy of Nurse Practitioners; American Academy of Pediatrics; American Osteopathic Association; American Academy of Family Physicians; National Physicians Alliance <http://npalliance.org/> ; and the National Association of Pediatric Nurse Practitioners.
Bill Summary: Preserving Patient Access to Primary Care Act of 2009, H.R. 2350
Findings on the Importance of Primary Care
Findings: Statement by Congress on the importance of primary care in improving outcomes and
reducing costs; recognition by Congress that primary care is facing an imminent shortage of
physicians trained in general internal medicine, family medicine and pediatrics.
TITLE 1: Medical Education Incentives
Medical education grants to support primary care: Establishes grants to teaching institutions to improve primary care education and training for medical students. Requires grant funds to be used for: (1) the creation of primary care mentorship programs; (2) curriculum development for population-based primary care models of care such as the patient centered medical home and (3) increased opportunities for ambulatory, community-based training.
The bill also creates several different pathways for providers who agree to practice in a primary care field to have their medical education expenses paid for or reduced through scholarships and repayment of debt linked to a service obligation and loan deferrals:
Scholarship for medical students who meet a service obligation in a critical shortage health facility: A Critical Shortage Health Facility is defined as a public or private nonprofit health facility that does not serve a health professional shortage area, but has a critical shortage of physicians (as determined by the Secretary) in the field of family practice, general internal medicine and pediatrics. A critical shortage health facility could award up to $30,000 per year in scholarships to medical students if they agree to complete a residency in the field of family practice, internal medicine, or pediatrics, and after completing the residency, to serve as a primary care physician at such facility in such field for a time period equal to the greater of one year for each school year for which the individual was provided a scholarship, for a minimum of two years of service.
Loan forgiveness for physicians, nurses, and nurse midwives who meet a primary care service obligation in a critical shortage area: The federal government would agree to pay, for each year of primary care service in a critical shortage area, not more than $35,000 of the principal and interest of the undergraduate or graduate educational loans of a primary care provider if the provider agrees to serve as a primary care provider in the field of family practice, internal medicine, or pediatrics. A critical shortage area is an area that is not a health professional shortage area (as defined in this Act), but has a critical shortage of physicians in such fields. Critical shortage areas will be designated for primary care and OB/GYN professionals, and OB/GYN physicians will be eligible for loan forgiveness in those OB/GYN shortage areas. The service requirement can be satisfied through employment in a solo or group practice, a clinic, a public or private nonprofit hospital, or any other appropriate health care entity.
Loan deferment: Amends the Higher Education Act of 1965 to allow medical residents in family medicine, internal medicine, and pediatric training programs to defer education loan repayment throughout the graduate medical training period.
Title II: Medicaid-Related Provisions
Grants to States: Provides grants to states to incorporate the Patient Centered Medical Home (PCMH) into Medicaid and SCHIP and to implement all payer demonstration projects. The PCMH ensures that a practice has the infrastructure and capability to provide patient- centered, physician-guided coordinated care. It is designed to provide participating patients with direct and on-going access to a primary or principal care physician who accepts responsibility for providing first contact, continuous and comprehensive care, in collaboration with teams of other health professionals as appropriate.
Title III: Medicare-Related Provisions
Medicare Payment Reforms: Improves payment systems under Medicare to support, sustain, and enhance the practice of primary care:
Changes the way that Medicare determines budget neutrality for physician services to consider the impact of primary care in achieving Medicare system-wide savings. For example, Medicare would be directed to consider the impact of care coordination by primary care physicians in achieving measurable reductions in avoidable hospital admissions for patients with chronic diseases.
Directs Medicare to pay for specific care coordination services billed on a fee-for-service basis that have been shown to improve outcomes for patients with chronic illnesses.
Directs Medicare to increase payments for services provided principally by primary care physicians through a separate modifier or bonus payments.
Requires that Medicare transition to a new payment methodology for qualified patient-centered medical homes (PCMH) that will expand upon the current Medicare demonstration project in eight states by allowing qualified PCMH practices nationwide (not limited to those participating in the demonstration project) to receive monthly payment for care coordination to qualified beneficiaries. Nurse practitioners and Nurse Practitioner Managed Practices will be eligible as medical homes according to the same standards applied to physician practices.
Requires HHS to study and report back to Congress on the process for determining relative values for the fee schedule to assure sufficient expertise and representation of primary care physicians
Increases Graduate Medical Education Residency Caps: Amends Title XVIII of the Social Security Act to direct the Secretary of HHS to increase the Medicare caps on the total number of full time equivalent residents, while requiring that existing teaching institutions maintain or increase their primary care residency capacity and that new programs give preference to residents seeking to specialize in a primary care field. Also eliminates barriers to increased training in ambulatory settings.
Assistance to practices in becoming PCMHs: Provides funding for Quality Improvement
Organizations to assist small and mid-size practices in acquiring the capabilities needed to become a PCMH.
Preventative Care: The bill includes provisions to support preventative care.
Eliminates time restriction for initial preventive physical exam
Eliminates cost-sharing for preventive benefits under Medicare
Requires HHS to study and subsequently report on facilitating the receipt of preventive health services under Medicare
Other Provisions to Support Primary Care:
HHS study and subsequent report on improving the ability of physicians to assist Medicare beneficiaries in obtaining needed prescriptions under Medicare Part D
HHS study and subsequent report on improved patient care through increased caregiver and physician interaction
Improved patient care through expanded support for limited English proficiency services
Assess the ability of the Medicare program to engage in real-time claims adjudication for services provided
Title IV: Studies
Primary Care Studies: The bill mandates several studies on ways that the federal government can support primary care including:
An evaluation of the higher education-related indebtedness of medical school graduates in the United States at the time of graduation and the impact on specialty choice including the impact on primary care
An evaluation of minority representation in training and in practice in primary care specialties and issue recommendations for achieving a primary care workforce that is more representative of the U.S. population
Designation of Primary Care as a Shortage Profession: Recent studies have shown that the number of primary care physicians is declining at an alarming rate. For example, only two percent of fourth year medical students plan to work in internal medicine, compared to nine percent in 1990, according to a September 2008 survey of the Journal of the American Medical Association. The Department of Labor shall study the criteria for designation of primary care physicians as shortage professions, including the statutory changes that would be necessary to make such a designation.
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