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Internists: Budget Agreement Delivers on Funding Essential Health Programs, Reducing Administrative Burdens, and Expanding Chronic Care Services

Statement attributable to:
Jack Ende, MD, MACP
President, American College of Physicians

Washington, DC (February 9, 2018, updated February 12) — The American College of Physicians (ACP) applauds Congress for passing a bipartisan budget agreement today that will result in remarkable health policy gains for patients and their physicians, delivering on many of ACP’s top advocacy priorities. We are especially pleased that the bill passed by Congress not only extends short-term funding through March 23, but that it also creates a multi-year framework to secure and increase funding for essential health programs, reduces administrative burdens on clinicians, and expands Medicare coverage for services provided to patients with multiple chronic diseases.

Specifically, the bill reauthorizes the Children’s Health Insurance Program (CHIP) for another four years, in addition to the 6-year extension already enacted by Congress. Millions of children and their families will benefit from knowing that CHIP funding is now assured for a total of 10 years.

It also increases budget caps in 2018 and 2019 for both domestic spending and defense spending, with billions of dollars more being specifically directed to the Centers for Disease Control and Prevention, the National Institutes of Health, and programs to address the opioid epidemic, as ACP recommended.

We are also glad to see that the National Health Service Corps, the Teaching Health Center Graduate Medical Education program, and Community Health Centers—all of which provide valuable resources for vulnerable communities across the nation and help train the next generation of primary are physicians—are reauthorized for two years.

Additionally, we support the provisions that will better facilitate chronic care management.  The agreement extends the  Independence at Home Medical Practice Demonstration Program, which provides a home-based primary care benefit to high-need Medicare beneficiaries with multiple chronic conditions; allows Medicare Advantage plans to offer a wider array of targeted supplemental benefits to chronically ill enrollee; and beginning in 2021, payments will be authorized to  physicians furnishing telehealth consultation services in all areas of the country for the purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, eliminating current geographic restrictions. The agreement also expands coverage of telemedicine services by Medicare Advantage Plans and Accountable Care Organizations.

The agreement eases Medicare’s regulatory burdens on clinicians, removing the mandate that electronic health records Meaningful Use/Advancing Care Information standards become more stringent over time. It also makes several other important improvements in Medicare’s Quality Payment Program.

ACP is also glad to see that the final legislation did not include a provision, included in an earlier version of the budget legislation as passed by the House, which would have extended a policy of imposing continued across-the-board Medicare payment cuts to physicians as a result of the unworkable “misvalued code policy” from the Protecting Access to Medicare Act (PAMA). While the decision not to extend this policy is a welcome development for physicians and their patients, directly addressing concerns expressed by ACP and other physician membership organizations in a Feb. 5 letter to congressional leadership, the final legislation still includes a reduction in the update to the physician fee schedule conversion factor for 2019 to 0.25 percent, albeit half of the anticipated reduction that would have resulted from continuation of the PAMA provisions. ACP urges Congress to do everything possible in the future to ensure positive and stable updates to physicians to support their transition to new delivery models, as Congress intended under the MACRA law.

In addition, ACP is pleased to see the funding for disaster relief that is being provided for Puerto Rico and other areas affected by natural disaster.  We are especially glad to see the increase in Medicaid funding for Puerto Rico.

Finally, while ACP strongly supports the overall funding priorities embodied in the agreement, we remain concerned that it contains a substantial cut to the Prevention and Public Health Fund.

In moving forward, ACP calls on Congress to uphold their promises to America’s Dreamers, many who are medical students and resident physicians, by taking take immediate action to ensure that current and future Deferred Action for Childhood Arrivals eligible-recipients are allowed to continue their studies and employment without fear of deportation, and to carve out a road to permanent citizenship before the next continuing resolution ends.

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About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.