Committee Reports

Legislative Affairs Committee Report

Legislative Affairs Committee Report

For the past several years, I have often felt like the “boy who cried wolf” from the classic Aesop fable. Each year, we put the call out to our members to fight to save Title VII funding, and each year we received around the same amount of funding. This year, the call was put out once again and, unlike the villagers, our members responded to the call to save Title VII. Unfortunately, the wolf came in the form of Congress and decimated the Title VII funds that allow primary care educators to develop unique and innovative education programs. While this call for action was a large part of our efforts over the past year, graduate medical education and a new initiative regarding the National Institutes of Health also occupied our time. What follows is a recap of the legislative activity of STFM over the past year.

Title VII Appropriations
While the administration’s budget once again zeroed out funding for Title VII, Section 747, for the first time it looked like Congress might do the same. In fact, the House zeroed out our cluster this year. The Senate, however, was much more supportive and appropriated an increase to this program in their bill. T he Senate version would have given Title VII, Section 747 programs $90 million. A conference report negotiated between the House and Senate would have provided only $28.2 million. This initial conference report was defeated, due to the efforts of many of our members and especially the rural health contingent. When renegotiated, Title VII, Section 747 was given $41.3 million, a 54% decrease from last year. This was the final amount approved by both Houses of Congress and signed by President Bush.

While this was a difficult blow, we did manage to do two things. First, we managed to save the program from being deleted completely; it is much easier to advocate for increased funding from a lower amount than to create entirely new funding. Second, according to Congressional staff, any funding was a victory and to get more put back in to the second conference was due to the support we have in Congress for our programs. Many thanks to all of our members for their advocacy efforts in fighting to keep Title VII, Section 747 funding alive.

Graduate Medical Education
The use of volunteer preceptors to train residents remains an issue that we are working on with the Centers for Medicare and Medicaid Services (CMS) At the core of the issue is that CMS will not pay either indirect medical education (IME) or direct medical education (DME) dollars for time spent by residents in non-hospital settings with volunteer preceptors. Several residency programs have been audited and asked to give money back to CMS for these types of arrangements. We have long been advocating for a change in the interpretation of regulations to remedy this situation. Unfortunately, despite many meetings with CMS administrators and the backing of many in Congress, we have been unable to remedy this situation to this point.

Thanks to the hard work of our Washington, DC, staff leader Hope Wittenberg, MA, and our partners at the American Osteopathic Association and the American Association of Medical Colleges , bills were introduced in both Houses of Congress to remedy the situation. On the Senate side, Senators Olympia Snowe (R-ME), Susan Collins (R-ME), and Senator Richard Durbin (D-IL) introduced this bill and on the House side it was Representatives Kenny Hulshof (R-MO) and John Tanner (D-TN). Both bills (S. 2071 and HR 4403) are currently in committee. We need more cosponsors to show Congressional concern on this issue.  

Title VII Reauthorization
With our proposal for a recrafting of Title VII, Section 747 being circulated by STFM (through AFMAA) and AAFP , we are slowly making progress on a new authorization for Title VII. While funding keeps getting cut, we view a new authorization as potentially a way that funds to these programs may actually increase by revising how and why the grants are awarded.

We expect the drafting of a reauthorization bill to begin on the Senate side under the leadership of Senator Michael Enzi (R-WY), chair of the Senate HELP committee. Our family medicine Washington, DC, staff were the first representatives of primary care organizations to meet with Senator Enzi’s staff this year to discuss possible legislative language for this reauthorization. While Senator Enzi is committed to the Title VII reauthorization process, it is unknown, given the time constraints of a shortened session, if this will receive a high enough legislative priority to have any bill introduced prior to the mid-term election.

NIH Reauthorization
An exciting new area that the Society is beginning to lay legislative advocacy groundwork is the area of NIH reauthorization. This past year, Representative Joe Barton (R-TX) began hearings regarding the reauthorization of NIH. In the past, family medicine did not play a role in the advocacy efforts for NIH funding or authorization. With the increasing successes of family medicine in the research arena and a priority to increase this effort in the Future of Family Medicine report, we felt this was an area in which family medicine needed to become involved.

In November, the STFM Legislative Affairs Committee brought to the AFMO Legislation and Federal Advocacy S ubcommittee a request that the NIH reauthorization be counted among the issues for which family medicine advocates . The AFMO Subcommittee requested that a think tank be convened in early January to discuss the role of family medicine in advocating for NIH.

Each of the family medicine organizations (AAFP, ADFM, AFMRD, NAPCRG, and STFM) were invited to send representatives to this meeting. A total of 23 individuals gathered in Washington, DC, over a relatively warm winter weekend to discuss our role. The end result of this discussion was to ask each AFMO member o rganization to adopt a policy that supports the inclusion of statutory language in the NIH authorization that defines translational research and assures its permanent existence as a component of the activities within NIH, independent of who holds the director position. As of this time, all of the Boards have approved this, and we are beginning to move forward in this advocacy arena.  

Advocacy Efforts
STFM presented its second annual Advocate Award to Daniel Onion, MD, of the Maine-Dartmouth Family Medicine Residency Program in Augusta, Maine. Dr Onion was presented this award for his long-term advocacy efforts in the area of graduate medical education. Our first knowledge of the issue of funding regarding the use of volunteer preceptors was from Dr Onion. His efforts in developing a personal relationship with both of his senators and their staff, and in getting residency directors across the country involved in similar efforts, is a testimony to the knowledge that one person really can make a difference.

As Legislative Affairs Committee chair, I would like to thank all members of the STFM Legislative Affairs Committee, but especially our two retiring members, Sam Romano, PhD, and Mack Worthington, MD, for all of their efforts. Other committee members include Kathleen Ellsbur y, MD, MSPH; Dan Lasser, MD; Mike Ma harry, MD; Osman Sanyer, MD; and Rick Streiffer, MD. Their hard work and dedication to the Society make chairing the committee a pleasure.

I would also like to acknowledge the incredible work and dedication 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 Leah Cohen, who left our office to begin a new adventure in Washington, DC, with the Medical Group Management Association. Her departure was difficult and placed extra responsibilities on Hope, who handled them with enthusiasm and grace.

Finally, I 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