SGIM’s Health Policy Committee (HPC) is driven by our vision for a just system of care in which all people can achieve optimal health. In pursuit of that vision, the HPC has been extremely busy in the 2023-24 academic year. As the year reaches an end, I asked Dr. Fischer to share his thoughts about the most important activities of the HPC.

EB: What were the most important priorities of the HPC in the last year?

MF: The HPC covers many topics, reflecting the active work of our three subcommittees: clinical practice, education, and research. According to the health policy agenda set at the beginning of the year, the committee identified its top priorities for “active advocacy” in which members, staff, and policy consultants from CRD Associates are heavily involved:

  1. Advance anti-racist policies and use an anti-racist lens to evaluate policies within the scope of the committee;
  2. Ensure that existing and new payment and delivery systems support high-quality primary care for all patients;
  3. Ensure that evaluation and management services reflect the full range of care provided during primary care and cognitive office visits;
  4. Support robust investment in graduate medical education (GME), including an increased number of GME slots for primary care and other specialties with shortages;
  5. Reform the Medicare GME program, including establishment of a payment structure that supports primary care, is transparent, holds institutions accountable for training outcomes, and results in a highly trained, appropriately distributed workforce;
  6. Advocate for a supportive policy environment for the National Institute on Minority Health and Health Disparities (NIMHD) and more funding across the National Institutes of Health (NIH) to promote health equity and reduce disparities;
  7. Support funding for the NIH and Agency for Healthcare Research and Quality (AHRQ);
  8. Retain and enhance the Clinical and Translational Science Awards program; and
  9. Secure funding to assess the impact of emerging value-based payment and primary care research programs and their impact on vulnerable populations.

In addition to the priorities for active advocacy, the HPC identified priorities for “coalition advocacy,” for which we work collaboratively with other organizations to advance SGIM’s positions. Those priorities are to:

  1. Ensure that all patients have access to affordable high-quality health care;
  2. Support steps to address substance use disorder and addiction;
  3. Allocate robust funding for Health Resources and Services Administration (HRSA) Title VII programs;
  4. Support collection, analysis, and dissemination of information related to healthcare workforce supply and demand;
  5. Eliminate barriers to entering and remaining in primary care;
  6. Foster innovative education and training programs;
  7. Improve financing of training for careers in primary care;
  8. Streamline the visa application process for physicians;
  9. Support governmental funding for health services, primary care and health disparities research; and
  10. Eliminate restrictive research policies on topics like gender affirming care and prevention of gun violence.

This wide range of advocacy reflects the diversity of interests among SGIM members and those who participate in the HPC.

EB: In what areas did the HPC find the greatest opportunities to make a difference?

MF: The most impactful work happens through the efforts of the subcommittees and their members who commit the time needed to identify issues and engage with policymakers. Through the Health Policy Clinical Practice Subcommittee, led by Dr. Anders Chen, we were highly engaged in advocating for changes in physician payment and better support for primary care. We supported the proposal by CMS to implement the G2211 code in the 2024 Medicare Physician Fee Schedule.1 This code is now available for use to increase reimbursement for patients who need continuing care for a single serious condition or a complex condition. We worked closely with the Primary Care Collaborative and the American College of Physicians to advocate for adoption of a hybrid payment model to increase support for primary care. This approach is currently being considered in the U.S. Congress. We met with leaders at CMS to encourage them to change how reimbursement rates are set for evaluation and management services. We urged them to establish a technical advisory committee that would provide advice on the valuation of physician services. This idea was discussed at a recent Congressional hearing on “How Primary Care Improves Health Care Efficiency.”2 A related sign of growing CMS support for primary care is its recently announced Accountable Care Organization (ACO) Primary Care Flex Model.3 The model will test how prospective payments and increased funding for primary care in ACOs will impact health outcomes and costs of care.

Through the Health Policy Education Subcommittee, led by Dr. Daniella Zipkin, we supported an increase in the number of GME slots allocated by the Medicare Program, including support for the Substance Use Disorder Workforce Act of 2024 that proposes 1,000 new GME positions in hospitals with accredited training programs in addiction medicine. We joined forces with other organizations in preserving funding for HRSA’s Title VII programs and fighting to protect the role of the U.S. Department of Veterans Affairs in medical education. The subcommittee also prepared a white paper calling for a unified national healthcare workforce policy.

Led by Dr. Peter Cram, the Health Policy Research Sub-committee led strong advocacy for the funding that Congress appropriates for the research supported by the U.S. Department of Health and Human Services (DHHS). Several members of the subcommittee participated in virtual meetings with Congressional staff about SGIM’s requests for such appropriations. Despite Congressional pressure to greatly reduce funding for DHHS agencies and eliminate funding for AHRQ, recently approved legislation provided $47.081 billion for the NIH (1% less than fiscal year 2023) and only a small decrease in funding for AHRQ. In mid-April, the subcommittee submitted a letter to CMS calling for them to change their plans to increase what they charge researchers for use of CMS claims data.

EB: What else would you like to highlight about the HPC’s activities in the last year?

MF: Thanks to the leadership of Drs. Mark Schwartz and Tracey Henry, we have continued to support the Leadership in Health Policy Program (LEAHP) which cultivates a cadre of skilled health policy advocates, leaders, and educators. Many members have benefitted from the superb mentoring provided by the program. At the 2024 Annual Meeting, we will announce the inaugural recipient of the John Goodson Leadership in Health Policy Scholarship, in recognition of Dr. Goodson’s exceptional contributions to SGIM’s advocacy efforts.

References

  1. Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule. CMS. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule. Published July 13, 2023. Accessed May 15, 2024.
  2. Whitehouse holds hearing highlighting how strengthening primary care would improve patient health, reduce costs. US Senate Budget Committee. https://www.budget.senate.gov/chairman/newsroom/press/whitehouse-holds-hearing-highlighting-how-strengthening-primary-care-would-improve-patient-health-reduce-costs. Published March 6, 2024. Accessed May 15, 2024.
  3. ACO Primary Care Flex Model. CMS.gov. https://www.cms.gov/priorities/innovation/innovation-models/aco-primary-care-flex-model. Accessed May 15, 2024.

Issue

Topic

Health Policy & Advocacy, SGIM

Author Descriptions

Dr. Bass (basse@sgim.org) is the CEO of SGIM. Dr. Fischer (Michael.Fischer@bmc.org) is the Chair of SGIM’s Health Policy Committee

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