Report from Capitol Hill

We just finished our 9th annual Capitol Hill Day, where AMGA members laid out their priorities and strengthened relationships with Members of Congress and their staff. I want to let you know about some of things we’re doing in Washington and some of the issues we discussed with lawmakers.

Capitol Hill Day

On this year’s Capitol Hill Day, over 40 medical group leaders from across the country came to Washington, DC to meet with their Members of Congress and discuss important issues for multispecialty medical groups and other organized systems of care.

Our members had over 100 meetings with policymakers and discussed ACO changes, preserving Medicare Advantage, how to fix the SGR, preserving advanced diagnostic imaging services in medical groups, support for the development of multispecialty medical groups and other high-performing health systemsTM, and ensuring that Rural Health Clinics can receive electronic health record incentives.

AMGA members have a unique message, one that is different from the rest of the industry.  We focus on managing populations of patients through better care processes, practicing in teams and using sophisticated analytics to drive quality.  This message always resonates on the Hill and this year was no different.  Attendees told us their Congressional delegations were eager to learn how medical groups improve care and lower cost.

Also part of this year’s program, Senator Maria Cantwell (D-WA) was presented with AMGA’s Congressional Leadership Award, which honors an outstanding Member of Congress for the significant work they do on behalf of medical groups and other organized systems of care. 

Progress with the SGR

As we all know, Congress didn’t pass a wide-ranging SGR repeal bill; instead they passed a 15-month patch that averted the 29% cut that was scheduled for April 1, 2014.  Many in Congress are still pushing to pass a 10-year repeal bill either during the Lame Duck session of Congress (after the mid-term elections) or before the current patch ends on March 31, 2015.

From what we’re hearing, the sentiment to pass a repeal is genuine, particularly among Members like Ron Wyden (D-OR), Fred Upton (R-MI) and Dave Camp (R-MI), but until Congress identifies how it will fund the approximately $170 billion to “pay for” the repeal, I’m skeptical.  And if the Senate flips to the Republicans in November, the new Majority may want to take a new look at the current SGR repeal legislation and add some of its own tweaks, including, possibly, changes to the ACA.  New leaders in health care on the House side may also want to add their own changes to a SGR repeal bill.

Changes to the ACO Program

The Medicare ACO program needs change―operational and financial.  With help from AMGA members, we developed a detailed issue brief regarding the changes necessary to make ACOs successful.  We’re convinced CMS can make changes on issues like attribution and risk-taking that will incent current ACOs to remain in the program and bring new medical groups into the MSSP and Pioneer programs.  CMS drafted a proposed rule on ACOs that will be released soon, either with the Medicare Physician Fee Schedule or as a standalone rule. 

As you may recall, AMGA and several of our member ACO leaders met with CMS officials in February to recommend ACO refinements. It will be interesting to see if CMS makes these changes.  If not, it may be time to get Congress involved.

What Is Happening in Medicare Advantage?

In terms of Medicare Advantage, I don’t see Congress making any changes to the program this calendar year.  The next step will be, as always, when CMS releases its Call Letter in February.  We’ll have a much better idea of what cuts CMS proposes to the MA program then.  AMGA has strongly lobbied Congress to leave MA rates untouched, given the alignment of MA incentives with the kind of patient-centered care our medical groups provide. 

How You and AMGA Fit In

Many medical group leaders will ask, rightly, "Why should I attend Capitol Hill Day? Congress isn’t quite the bi-partisan body it was 20 years ago, and little gets done until the very last day/minute.  Why should I spend two days in Washington when I have some fairly important matters to take care of at my group … like figuring out how to survive in a new world of reduced reimbursements and transitioning to value?"

Good questions, and here are some answers:  First, with the passage of the Affordable Care Act (ACA or Obamacare), the federal government’s role in health care has never been bigger.  And it will continue to grow, especially as the exchanges take hold and the government continues to push a value-based agenda on providers.  Add to that the fact that revenues from Federal healthcare programs exceed 50% for many AMGA members, and you have, I think, two excellent reasons to meet with your Federal policymakers.  We don’t want policy to be made in a vacuum and if you’re not in DC to tell Congress how ACOs need to be refined, or how MA rates need to remain stable, or how amending the Stark self-referral law will mean you can’t provide advanced imaging to your patients, then someone else will be―and they may not be looking out for your interests. 

AMGA DOES look out for your interests every day, and I think we do a good job representing you.  But, to be successful, we need to partner with you to more completely tell the medical group story to the Congress.  The personal relationships you can build with your legislators as their constituents and some of the most important employers they represent cannot be overstated.  We see that when these relationships exist in our membership, lawmakers will come to you for answers and guidance and then come to us as your industry representative, a model that’s worked very well for the past several years. 

So, I hope you’ll consider attending Capitol Hill Day next year and I encourage you to get involved with AMGA’s advocacy efforts. We have a dedicated staff here ready to answer your questions and help you advocate for your group in Washington.

Feel free to contact me at any time at cspeed@amga.org.

Chet Speed
Vice President of Public Policy
American Medical Group Association

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