1. Academic Family Medicine Advocacy Alliance Here Comes the Sun ??  Stimulus bill (American Recovery and Reinvestment Act (H.R. 1)  Title VII FY09 appropriations  FY2010 Budget and appropriations  Health Care Reform – Senate Finance Title VII reauthorization GME reform Volunteer preceptor

2. Academic Family Medicine Advocacy Alliance Stimulus Conference Agreement – Health Issues $10 billion NIH $1.1 billion comparative effectiveness at AHRQ (some of the money will go to NIH) The word clinical dropped – without prejudice. $3 billion for adoption of Health IT programs (appropriations) $16.38 billion for IT (Ways and Means) $2 billion Community Health Centers $1 billion prevention/wellness trust (including vaccines) $500 million Indian Health Service $500 million – Health Workforce Investment (Title VII and VIII)

3. Academic Family Medicine Advocacy Alliance Title VII Stimulus $ Where Is It? When is it coming? Who can apply for it?

4. Academic Family Medicine Advocacy Alliance Health Workforce Investment  $200 million distribution All disciplines in the primary care cluster Dental Public Health and Preventive Medicine residency programs Scholarship and loan repayment programs authorized under Title VII and Title VIII (loans and/or scholarships for disadvantaged students, faculty) Grants to training programs for equipment Funds may also be used for cross-state licensing agreements for health care specialists

5. Academic Family Medicine Advocacy Alliance Health Workforce Investment  Possible distribution mechanisms considered by HRSA Publish new guidance for all programs Publish new guidance for selected programs Supplement funding to existing grants Grants for equipment – for new grants or existing supplements Approved but unfunded grants from previous year.

6. Academic Family Medicine Advocacy Alliance Health Workforce Investment  Request to the field through list serves  Great response  Letter to new HRSA Administrator recommending: Requesting doubling of current primary care cluster funding ($48 million X2) Focus on those training activities and educational research activities that prepare graduates for the realities of future practice. Open a two-year grant cycle for primary care medicine training grants.

7. Academic Family Medicine Advocacy Alliance Health Workforce Investment  What types of equipment? prioritize equipment that has a training function. simulation aids and related software videoconferencing and telemedicine equipment, and video recorders for direct observation of trainees and review of clinic sessions equipment such as colposcopes with video teaching or microscopes with teaching heads or other equipment including training videos that accompany the teaching equipment

8. Academic Family Medicine Advocacy Alliance Health Workforce Investment  Two year grant cycle to: allow for departments and residency programs to develop training curricula and programs for practice in new models of care, such as the patient centered medical home (PCMH). Funding is needed to support all aspects of the educational program -- development, evaluation, and personnel. allow for the purchase of a broader range of equipment that will help bring training into the 21st century to meet practice needs.

9. Academic Family Medicine Advocacy Alliance Developments at HRSA  Assistant Secretary for Health Named Howard Koh, MD, Harvard School of Public Health  New HRSA Administrator Mary Wakefield, PhD, RN, FAAN  Acting HRSA Deputy Administrator Marcia Brand  New Director, Division of Medicine and Dentistry Daniel Mareck, MD – family physician  New Deputy Director, DoM, Lieutenant Commander Shari Campbell -- podiatrist

10. Academic Family Medicine Advocacy Alliance Title VII FY09 appropriations FY 03FY 04FY 05FY 06FY 07 FY 08 FY09 Appropriation 92.4 81.288.840.848.847.998 48.4 Budget Request0000*** No new cycles for 747 for FY09 with this level of funding

11. Academic Family Medicine Advocacy Alliance President’s FY2010 Budget  President’s Budget Workforce provisions:  $330 million to address the shortage of health care providers in certain areas.  expands loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas.  allow states to increase access to oral health care through dental workforce development grants.

12. Academic Family Medicine Advocacy Alliance Budget Resolution FY2010  Just passed this week  $388.9 billion in outlays for 2010 for discretionary health spending  $449.8 billion in outlays in 2010 for Medicare  Budget reconciliation measure for health care reform

13. Academic Family Medicine Advocacy Alliance Budget Resolution 2010  increased funding for the President's health priorities for NIH, HRSA, CDC, IHS, and FDA  HRSA -- significant increases for CHCs, health professions, and NHSC  public health -- addressing health promotion and disease prevention.  Senate and House reserve funds comprehensive health reform legislation including legislation for improvements in Medicare's system for paying physicians.

14. Academic Family Medicine Advocacy Alliance Health Care Reform -- Risk and Opportunity  Environment for Reform  What does Reform mean?  What does it mean for Primary Care?  What’s been happening on the Hill?

15. Academic Family Medicine Advocacy Alliance Delivery System Reform  Flipping the Pyramid – Primary Care Seen as Key to Solve many woes “Bend the Curve of Health Care Costs” Quality – need to improve health outcomes Access – usual source of care

16. Academic Family Medicine Advocacy Alliance Health Care Reform: Win or Lose ??? ???

17. Academic Family Medicine Advocacy Alliance Senate Finance Policy Options Transforming Delivery System  Released this week  Improve patient care  Reduce health care costs  Includes payment reform for many providers  Links payment to quality outcomes

18. Academic Family Medicine Advocacy Alliance Senate Finance Policy Options  Emphasis more on accountability and quality than on transforming and supporting primary care  Behind Closed Doors Walk –through yesterday – no information yet on what the opinions of the members were  What might be changed  Public comments due May 15

19. Academic Family Medicine Advocacy Alliance Senate Finance Policy Options Physician Payment  Doesn’t reform SGR; sets conversion factor at 1%  At least 5% bonus for primary care physicians based on 60% services in certain EM codes, home visits or nursing home visits Means a 0.5% cut for other physicians – totals out to a 0.5% increase for them; at least 6% increase for primary care  Are other mechanisms for additional payment; care management fee for transitional care

20. Academic Family Medicine Advocacy Alliance Senate Finance Policy Workforce Issues  Redistribution of unused residency slots  3 yr average; 80% of unused slots would be redistributed  We don’t know how many slots are unused at this time?  75% of unused slots would go to primary care or general surgery  Hospitals can request up to 50 additional slots

21. Academic Family Medicine Advocacy Alliance Senate Finance Policy Workforce Issues  New slots would be prioritized PCHPSA Rural Small urban <1 million States with more graduates than slots States with higher than average population growth Must demonstrate the likelihood of filling

22. Academic Family Medicine Advocacy Alliance Senate Finance Policy Workforce Issues  IME/DME Reimbursement would not be reduced  If after three years hospital can’t fill the slots DURING the match they can be redistributed to other specialties

23. Academic Family Medicine Advocacy Alliance Promoting Great Flexibility for Residency Training Programs Options Include:  Counting didactic and research time  Remove current disincentives to training in non-hospital settings (i.e. volunteer preceptor payments)  Provide flexibility for programs that involve more than one hospital

24. Academic Family Medicine Advocacy Alliance National Workforce Strategy  Secretary directed to work with “external stakeholders”  Develop and set forth national workforce strategy Recruiting Training Retaining  To meet current and future workforce needs

25. Academic Family Medicine Advocacy Alliance Where to go from here?  Next several weeks Finance will be rolling out at least one more options paper on coverage  HELP committee will be releasing its proposals soon – perhaps by June  House committees also fast at work on bills  Will it be a sunny day??