ACP advocacy is on a roll

ACP has scored major victories in Medicare's proposal to pay for advance care planning, a grace period for converting to ICD-10 coding, and access to affordable coverage.

ACP advocacy has been on quite a bit of a roll of late, scoring win after win on issues ranging from paying internists more appropriately for their services to easing government regulations to reducing barriers to care for millions of Americans. Let's take a look at just some of the things that ACP has accomplished for internists and their patients since the start of the year.

In July, Medicare proposed paying physicians for discussing advance care planning with their patients. Although this has yet to be finalized (it is included in the annual proposed rule on the Medicare Physician Fee Schedule), the simple fact that Medicare has even proposed to begin paying for advance care planning is a huge victory.

Recall that Medicare in 2010 rescinded a proposal to allow coverage for “voluntary advance care planning” in Annual Wellness Visits because of a false charge that this would lead to “death panels.” ACP argued then, and has continued to advocate with Congress and Medicare ever since, that paying physicians for counseling patients on the importance of making their treatment wishes known in advance is a common-sense policy to put patients in control of their own health care instead of government and the health care system. It is great to see that our efforts have finally paid off, and we have every reason to believe that Medicare will finalize its proposal and begin paying physicians for advance care planning in 2016, this time with bipartisan support in Congress.

Also in July, CMS and the American Medical Association (AMA) jointly announced an agreement to create a grace period to protect physicians from being unfairly penalized for mistakes in using the new ICD-10 codes. The agreement states that for a 1-year period starting Oct. 1, Medicare claims will not be denied or audited solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. While the AMA appropriately deserves the greatest praise for negotiating this outcome, ACP played a part as well, having joined with the AMA and other physician membership organizations in writing to CMS in March to call for such a grace period.

In June, the Supreme Court issued 2 decisions on consecutive days to ensure that millions of Americans would continue to have access to affordable coverage, while breaking down barriers for millions more. In King v. Burwell, the Supreme Court, in a 6-3 ruling, upheld the Affordable Care Act's premium subsidies for low- and middle-class persons in states that have opted to let the federal government run their insurance exchanges.

In writing for the majority, Chief Justice John Roberts concluded that “Congress passed the ACA to improve health insurance markets, not to destroy them,” which is what would have happened if the court had instead ruled with the petitioners, as ACP had argued to the court in an amicus (friend of the court) brief jointly submitted by us and several other health advocacy organizations. Our brief noted that overturning the subsidies would have resulted in millions of Americans losing coverage while driving up premiums to millions more, a point the Chief Justice also made in his opinion.

Then, a day later, the Supreme Court ruled in a 5-4 decision, written by Justice Anthony Kennedy, that denying same-sex couples the right to enter into civil marriages is unconstitutional. ACP, in a position paper published in Annals of Internal Medicine a month earlier, had argued that excluding same-sex couples from civil marriage adversely affected their health. While we don't claim that the Supreme Court issued its decision directly because of ACP's advocacy, it did validate our view that allowing same-sex couples to enter into civil marriages is an important step to breaking down health care barriers to gay, lesbian, bisexual, and transgender people.

Now that same-sex marriage is legal in all states, 1 practical effect is that same-sex married couples will have the same access to health insurance coverage under Medicaid, through their employers, at Veterans Affairs (VA) facilities, and through ACA marketplace plans as other married couples.

In April, Congress passed and President Obama signed into law the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA), a bipartisan bill to repeal the Medicare sustainable growth rate (SGR) formula. This bill represented the culmination of more than a decade of ACP advocacy to eliminate the flawed SGR formula and to support the transition to models of payment that align incentives for value.

ACP played a key role not only in getting the overall bill passed but in ensuring that it included incentives for patient-centered medical homes and other primary care-based models that will allow internists to be paid more appropriately for providing high-quality, coordinated, patient-centered care.

In January, as long championed by ACP, Medicare began paying physicians for the work involved in chronic care management (CCM). While this was a good start in getting Medicare to begin paying for the physician and staff work that falls outside the usual face-to-face patient visit, ACP continues to advocate for ways to make the new code and payments easier to bill for and document. We are encouraged that the new Medicare Physician Fee Schedule proposed rule released in June requests comments on how to make the new CCM codes easier to use and better.

This is only a partial list of ACP's recent advocacy wins, which also included persuading Medicare to ease some of the most burdensome and unrealistic meaningful use requirements. To be sure, we've also had our disappointments, including Congress' failure to continue the Medicare Primary Care Pay Parity program when it expired on Jan. 1. We have our work cut out for us in persuading Congress to continue the Medicare Primary Care Incentive Payment Program. This program, which gives internists and other family physicians an additional 10% bonus on payments for their designated primary care services, is set to expire at the end of this year. We also recognize we have much more to do to reduce the regulatory burden on internists and to ensure that they are paid fairly and appropriately.

Yet, our advocacy achievements, especially over the past year, belie the cynical view held by some physicians that nothing ever gets done in Washington and that it is therefore pointless to support the advocacy efforts of ACP and physicians' other professional associations. Au contraire! ACP's persistent advocacy for internists and their patients is bearing fruit, yet one has to wonder how much more could be accomplished if all internists supported our efforts on their behalf.