Editor's Note
On January 7, 2010, the American College of Physicians (ACP) sent a letter to
key legislators urging them to ensure that the final healthcare reform bill includes provisions to support the primary care
workforce. The following is a summary of their recommendations.
Increase Payments to Primary Care Physicians
Include a 10 percent permanent increase in Medicare payments for designated primary care services, as defined
in the House bill (H.R. 3962), which includes office, nursing home, domiciliary, home and hospital visits. The eligibility
threshold for the increase should be 50 percent of the physician's total Medicare billings for such designated primary
care services, including hospital visits, as included in the House bill.
Increase Medicaid payments for primary care to 80 percent of Medicare in 2010, 90 percent in 2011, and 100 percent in 2012
and thereafter, as included in the House bill.
Expand Pilot-Testing and Implementation of the Patient-Centered Medical Home (PCMH)
Fund a Medicare pilot-test of two versions of the PCMH, an independent practice model and a community-based model,
as included in the House bill, but modify the patient eligibility threshold for the independent practice model from high-needs
patients, i.e. the sickest 50 percent of patients, to the more inclusive threshold of "one or more chronic conditions." Support
creation of a Medicaid medical home option, as in both the House and Senate bills, but modify it to be broadly inclusive
of all Medicaid patients.
Expand Existing Programs and Enact New Programs to Recruit and Retain Primary Care Physicians
Create a workforce commission, as included in both the House and Senate bills; adopt the Senate language that
requires the commission to analyze and make recommendations for eliminating barriers to entering and staying in careers
in primary care, including physician compensation.
Reauthorize and fund the Title VII Health Professions Programs at the highest level provided in either the House,
or Senate-passed, health reform bill through a mandatory funding stream, as in the House bill. Include the Senate's
provisions to remove ratable reduction language under Title VII, Section 747. Establish a new grant program to support
new or expanded primary care residency programs at teaching health centers, and provide Graduate Medical Education (GME)
funding directly to teaching health centers operating training programs, as included in the Senate bill. Include the House
bill's provisions to establish an Innovations in Interdisciplinary Care Training Program and increase faculty loan repayment
awards from $20,000/year to $35,000/year under the Title VII program. Increase funding to diversity programs, including the
Scholarships for Disadvantaged Students Program, under Title VII, as included in both bills. Reduce barriers to training in
community-based settings, as included in both bills.
Include the House's provision to create a Frontline Health Providers Loan Repayment Program for needed specialties
serving in communities of high need that are not within designated Health Professional Shortage Areas and require that 90
percent of awards be for primary care.
Reauthorize and fund the National Health Service Corps (NHSC) at the highest level provided in either the House,
or Senate-passed, health reform bill, through a mandatory funding stream; Create a part-time service option in the
NHSC for half the reward amount, and increase full-time awards from $35,000 to $50,000, as included in both bills.
Provide grants to institutions to plan, develop, operate or participate in an accredited professional training program,
including residency or internship programs in primary care specialties for medical students, interns, residents, or practicing
physicians, as both the House and Senate bills require.
Redistribute 90 percent of unused GME slots to primary care training programs in urban and rural areas, as included
in the House bill.
Create an exclusion from federal income taxes of state student loan repayment programs for certain health professionals,
as included in the Senate bill. Reinstate the 20/220 hardship deferment pathway, as included in an earlier version
of the Senate bill (S. 1679).
Create a Primary Care Training Extension Program to assist primary care practices, as included in Senate bill
