Medical groups make push for primary care in Washington

The American Academy of Family Physicians (AAFP) is part of the group of six medical organizations that have joined for a week of action happening now in the nation’s capital.

AAFP President Tochi Iroku-Malize, MD, MPH, MBA

They are making a final push on matters that would help primary care next year and beyond, before Congress ends its session in 2022 and new and returning lawmakers take their seats to reconvene in 2023.

AAFP President Tochi Iroku-Malize, MD, MPH, MBA, is a family physician in Long Island, New York. On Dec. 6, she was traveling from the Institute for Healthcare Improvement Forum in Orlando, Florida, to an AAFP board meeting near Kansas City, Kansas. Medical Economics caught up with her in transit for a discussion about critical legislation and policies.

The following transcript was edited for length and clarity.

Medical Economics (ME): What's happening in Washington, D.C., this week?

Tochi Iroku-Malize: We represent the nation's frontline physicians: the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetrics and Gynecology, and the American Psychiatric Association, as well as the American Osteopathic Association. All of us combined have more than half a million members and we are there trying to advocate for the health and well-being of American families. So that's really what's going on. We have some major priorities for Congress to address this year.

ME: Let's start with the Medicare Physician Fee Schedule. There are potential cuts that are looming for 2023. Can you talk about why that's so important for physicians?

Iroku-Malize: The Medicare cuts are a big issue for us. Patient access to care is going to be threatened as cuts to Medicare payments are going into effect at the beginning of the year 2023. And so to protect the Medicare beneficiaries, their access to care, we're urging Congress to pass the bipartisan Supporting Medicare Providers Act, which is House Resolution 8800. That negates the adverse effect of a 4.42% on Medicare physician payment and coverage in 2023, and provides an important measure of stability for physicians and their patients next year. We know that physicians are trying to do the right thing by their patients, they but they need to be able to keep their doors open, and that's a big concern for a lot of the physicians out there. A number of physicians are starting to question whether or not they can continue to have their practices open, whether they continue with their careers. Some people are changing careers, some people are going into early retirement, and we know that there's a need especially for primary care physicians. So this is an important issue that Congress needs to address urgently because the cuts go into effect as of January 2023.

ME: Another piece of legislation that remains pending is House Resolution 3173, the Improving Seniors’ Timely Access to Care Act. Why is that so important for physicians and patients?

Iroku-Malize: Prior authorizations divert valuable resources from patient care and they can delay the start of necessary treatment and result in negative clinical outcomes. So that's why we're urging the Senate to pass this act. It's bipartisan. It will protect the patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prioritization approval process in the Medicare Advantage program. I've seen cases where you have two patients with the exact same diagnosis and different types of managed care Advantage programs. And one is able to get the medication the required medication immediately, the third-tier medication immediately, whereas the other one has to go through a different prioritization process. And sometimes that has to go through two rounds of other medications before they finally get to the one that they need. And this can take up to 18 months. This example I have is an 18-month delay before finally being able to get to the final third tier of medication that would have been the best one for them. As physicians we’re trained to practice evidence-based medicine. Having an evidence-based protocol is important for us to do the prior authorization, so standardizing and streamlining it will help us with what we have to do to take care of our patients.

ME: AAFP has advocated for continuous eligibility for new moms and infants through the Medicaid Children's Health Insurance Program. How does that help physicians and their patients?

Iroku-Malize: This is important because, even looking at what's happening this season, with RSV infections, children and especially those who are under the age of 1, are being hospitalized for an illness that could be prevented, if we have preventive care and keeping track of the mom. And then in the United States, we know that we have high maternal mortality and morbidity rates compared to other countries that are well developed. This is just one step that will help us to address this issue. Medicaid and CHIP are essential sources of coverage for low-income families, including more than half of all children. That's why we're urging Congress to enact this 12 months of continuous coverage in the end of the year legislation to ensure that children and new mothers can rely on coverage. I mean, think about the how important it is for children to have preventive care, for medical management of these issues. That makes sense to cover them for that 12-month period, through either themselves or through their moms. We do a substandard job, like I said, when it comes to maternity health, so this is a small step to address that.

ME: We know that telehealth expanded greatly in the COVID-19 pandemic. What needs to happen for those flexibilities to remain in place?

Iroku-Malize: Telehealth has been a lifeline for physicians throughout COVID-19. I mean, it allowed us to continue to take care of our patients because, especially in primary care, we have that continuity of care, that relationship with our patients. So it allowed us to care for them while mitigating the exposure risks that happen with having to come into the office. The current short-term extension leaves us and the patients that we serve in a state of uncertainty and we're urging Congress to extend the Medicare telehealth flexibilities through at least Dec. 31, 2024, including coverage for audio-only services. There are concerns of, course, that those Medicare telehealth flexibilities need to extend to audio-only because there are a number of times where we can be doing a visual or audio-visual telehealth visit and then something happens with the video portion of the visit, and it becomes an audio-only. There are some individuals who cannot access audio-visual, so we have to only do audio visits. And so that's why we want the coverage to extend to that. And again, we have repeatedly called for additional studies of telehealth utilization to assess how the policy changes have occurred during this pandemic, and then using that information to figure out, how did it impact the access to clinical care? What are the patient outcomes, the care continuity across the different demographic groups? And to assess the disparities and inform any policy solutions to advance health equity. So this is really, really important to us.

ME: The Association of American Medical Colleges has projected physician shortages coming in the near future. Can you talk about how will that change through Teaching Health Center Graduate Medical Education?

Iroku-Malize: Teaching Health Center Graduate Medical Education is near and dear to my heart as an academic physician. It was incepted in 2011 and it has trained more than 1,730 primary care physicians and dentists; 63% of this population are family physicians and they're more likely to practice in underserved areas. We know that when we train a resident in a community, there's a chance that about 50% of those residents will stay in that community. This is really important because these programs have helped to service communities that are underserved when it comes to health care. Without the additional funding, this program will face a significant financial challenge that will result in reduced funding for residents and put these centers at risk for closure. And the way this works, I mean, we have medical students that are trying to figure out, where do I want to train? And some of them are drawn to underserved communities. But going to a program that you're not sure will still be there when you're in your third year of residency is concerning and that has made a few people say, you know what, I'd rather not gamble on this, I'd rather go to a one of the traditional graduate medical education programs. So we need this. We're urging Congress to include a multiyear extension so we don't have to go every year and advocate for an extension.

ME: What other issues should family physicians and primary care doctors be aware of?

Iroku-Malize: I do want to say that mental health is an important issue. One in five Americans are affected by mental health issues and substance use disorder annually and patients are struggling especially with COVID-19. We have found a lot of our youth, the children, the adolescents, young adults, are suffering disproportionately, and there are not enough resources for that. We want to make sure that Congress invests in the integration of behavioral health and primary care, are strengthening the behavioral health workforce, enforcing mental health parity, and increasing investment in prevention and early intervention.

ME: How can family physicians get involved through the AAFP Family Medicine Action Network?

Iroku-Malize: AAFP as an organization has a lot of resources when it comes to those physicians out there who are interested in doing some advocacy work. We have the action center that allows you to log on to the website, find out what issues are important to you. We have speakout sessions that allow you the simplicity of being able to address your legislator by sending email, gives you contact information to talk about the important points and important issues that are being addressed in Congress that affect you and your patients because you and your patients are constituents, right? And the legislators are concerned about their constituents. So bringing that voice to them, telling your patients’ stories to them, allowing them to understand what's going on in your communities, what's affecting you so that you can help your community, is important. So go to the action center, lots of resources, lots of information on what policies we're working on.