Committee Reports

Legislative Affairs Committee Report

This year has been one of change for the Legislative Affairs Committee with the election of a new Congress and the reelection of the president of the United States. Yet, as the old adage goes, “As much as things change, they stay the same.” The major issues facing this committee at the beginning of the year were graduate medical education issues, Title VII appropriations, Title VII reauthorization, and strategies to encourage our members to serve as advocates for academic family medicine. As the year draws to a close, these issues still remain paramount to the Legislative Affairs Committee and to STFM as a whole. Following are some details on these important issues:

Graduate Medical Education
The issue of using volunteer preceptors to train residents is at the forefront of our agenda with the Centers for Medicare and Medicaid Services (CMS). Basically, as STFM’s 2003–2004 year drew to a close, a 12-month moratorium on CMS’s activities to audit hospitals to recoup indirect medical education (IME) and direct medical education (DME) dollars for time spent by residents in a non-hospital setting where the preceptor is a volunteer also expired. The Office of Inspector General (OIG) conducted an investigation of this practice and acknowledged that supervisory physicians were not coerced into volunteering their time to supervise residents. In addition, the OIG recommended that CMS work with Congress to extend the moratorium for family medicine residencies. The OIG also recommended that CMS work with Congress in three areas: to further analyze the current financial arrangements and incentives among teaching hospitals, non-hospital settings, and supervisory physicians in these settings; to study the potential impact of any revisions of the current policy; and to clarify the definition of “all or substantially all” of the costs associated with training residents in non-hospital settings.

However, the 108th Congress had adjourned before the OIG report was released and could not act on any of the recommendations of the OIG. Currently, there are hospitals that are being audited by CMS and are being asked for money back in the case when IME or DME dollars were paid to hospitals for residents’ time spent with volunteer preceptors. We expect that renewal of this moratorium and passage of legislation to prevent this practice in the future will be our major Medicare activity for the coming year. Senators Susan Collins (R-ME) and Olympia Snow (R-ME) and Richard Durbin (D-IL) have been our strongest advocates in the Senate for this change. Representatives Kenny Hulshof (R-MO), Greg Walden (R-OR), Earl Pomeroy (D-ND), and John Tanner (D-TN) have been our key supporters in the House. We need to work to get increased support for them in their efforts to resolve this issue.

Another key issue facing CMS and Congress this year is the Medicare Sustained Growth Rate (SGR), which affects physician payment; the countervailing pressure is that if Congress opens up Medicare due to requirements to find budget savings, there are other areas that would be at risk that are of concern to academic family medicine, such as the IME update factor.

Appropriations
The House and Senate conferees finally agreed on FY05 appropriations in mid-November, and the president signed the omnibus bill shortly thereafter. The final amount of money dedicated to Title VII, Section 747 programs is $88.8 million, which is approximately a $7.0 million increase from FY 04. Of interest, it was the Senate that reinstated the money to the Appropriations package this year rather than the House. This was a victory for family medicine and one of which we should be proud.

The president released his FY06 budget and, as expected, Title VII was zeroed out. We will have another uphill battle to secure funding for FY06 and, according to many on the Hill, an equal amount of spending in next year’s budget should be considered a “win.” Similarly, rural programs were recommended to be cut to $29 million from $144 million in FY05, and AHRQ funding was kept at current levels. I urge each of you to continue the advocacy efforts that have kept Title VII, Section 747, rural health, and AHRQ research programs funded each year so that we can continue to educate future family physicians to meet the needs of our population.

Title VII Reauthorization
Last year, the Committee and STFM Board of Directors spent a great deal of time in developing and approving a concept paper detailing new ideas for the reauthorization of Title VII. This new conceptualization is based on requests, especially from the Office of Management and Budget, to address new outcomes measures for the program. STFM staff members have worked hard on communicating our vision for Title VII to the appropriate Hill staffers. However, with the 2005 election, changes have been made to the committee structure on the Hill. Thus, we must continue our educational efforts on the impact of Title VII programs to the staff and leadership of the Senate Health, Education, Labor and Pensions (HELP) Committee.

Advocacy Efforts
STFM presented its first annual Advocate Award to Jeffery Cain, MD, of the University of Colorado. Dr Cain was presented with this award in recognition for the development of the “Tar Wars” program, and his personal advocacy to support passage of prosthetic parity reform legislation to mandate insurance coverage for artificial limbs in Colorado and across the county. He continues to be a strong advocate for family medicine and the care of children. Dr Cain is an exemplary example of the types of advocacy efforts that should be a mainstream activity for all members of the Society. The second annual STFM Advocate Award will be presented at the 2005 Annual Spring Conference in New Orleans.

Future Efforts
The coming year promises to be a busy one for the Legislative Affairs Committee and the Society as a whole. With a newly elected president and Congress, the legislative agenda promises to be a lengthy one. The issues that will be at the top of STFM’s agenda will be: Title VII reauthorization, appropriations for Title VII programs, rural health and AHRQ, and working on legislation to deal with the issue of volunteer preceptors in Medicare.

As Legislative Affairs Committee chair, I would like to thank the members of the STFM Legislative Affairs Committee: Kathleen Elsberry, MD; Dan Lasser, MD; Mike Meharry, MD; Sam Romano, PhD; Osman Sanyer, MD; Rick Streiffer, MD; and Mack Worthington, MD. Their hard work and dedication to the Society make chairing the committee a pleasure. I would also like to acknowledge the hard work of our Washington, DC, staff. Hope Wittenberg, MA, government relations director, is an essential player in ensuring that the voice of academic family medicine is heard on the Hill. We also want to acknowledge the work of Kerri Connor-Wade, who left our office to begin a new adventure in Washington, DC, and to welcome Leah Cohen, our new government relations assistant. I also want to thank each of you, as members of STFM, for your personal advocacy efforts and ask that you continue this work to advance the efforts of our Society.

Terence Steyer, MD, Chair

Legislative Affairs Committee

Terrence Steyer, MD, Chair
Medical University of South Carolina

Kathleen Ellsbury, MD, MSPH
University of Washington

Dan Lasser, MD, MPH
University of Massachusetts

Michael Maharry, MD
University of Iowa

Samuel Romano, PhD
University of Michigan

Osman Sanyer, MD
University of Utah

Rick Streiffer, MD
Tulane University

J. Mack Worthington, MD
University of Tennessee, Chattanooga

STFM Staff Liaison
Hope Wittenberg, MA