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QPP: advocacy

CAFP advocates for higher payment for family physicians in California. Investment in primary care leads to improved quality of care, better patient health and lower health care costs overall. We also advocate for payment reform, to move our health care system from a fee-for-service model to a model that appropriately compensates physicians for high-value care. This means that family physicians should be paid for services, such as care management, that they have historically provided without pay. Read more about CAFP’s advocacy efforts on MACRA and payment reform.


MACRA Eliminates the SGR, Funds Primary Care Training Opportunities

CAFP and AAFP fought hard to end the flawed Sustainable Growth Rate (SGR) formula in the Medicare program. As a result of our advocacy, MACRA repeals the SGR and eliminates the threat of substantial payment cuts that family physicians faced year after year. Equally important, MACRA extends funding for the Teaching Health Center Graduate Medical Education (GME) Program. In doing so, the legislation continues training in community-based settings rather than in specialty-focused academic hospitals. This is a crucial step toward reforming the federal GME program to include training in the settings in which family physicians practice and individuals receive most of their health care. CAFP and AAFP also fought for continued funding of the National Health Service Corps (NHSC) and MACRA appropriates money to NHSC. NHSC maintains scholarships and loan repayments for medical students who choose primary care and provide those services to those living in underserved areas. Because of our advocacy, MACRA continues to both build the primary care physician workforce and address the needs of Americans living in areas that struggle with primary care shortages.


CAFP Comments on Proposed Regulations

In April of 2016, CMS published proposed regulations for MACRA and requested stakeholder comments. CAFP swiftly took action, identifying key concerns with the proposed regulations and submitting comments to CMS in June 2016. We are concerned about the complexity of the proposed regulations and called on CMS to delay the first measurement period to give physicians adequate time to prepare. We urged CMS to create opportunities for rural, solo and small practice family physicians to participate successfully in the Quality Payment Program and avoid financial penalties. We requested that CMS expand its definition of Advanced Alternative Payment Models so that more primary care physicians, not just those fortunate enough to be in states with a CPC+ program, could participate.

Our advocacy paid off. In the final rule, CMS created a more flexible start to the Program. Physicians who submit ANY data in 2017 can avoid a negative adjustment to their payment. Physicians who submit more data will get a positive payment adjustment. CMS included new accommodations for rural, solo and small practice family physicians, including an expansion of the low-volume exemption: a physician who has $30,000 or less in Medicare charges OR 100 or fewer Medicare patients annually is now exempt from MIPS. The final rule also streamlines the Quality Payment Program by eliminating measures in several performance categories.


CAFP Advocates for Streamlined Reporting Requirements

A key part of CAFP’s advocacy strategy with regard to payment reform is fighting for streamlined measurement that will reduce the reporting burden on physicians. As payment is increasingly tied to measurement, family physicians have faced cumbersome reporting requirements because of a lack of consistency among payers, who too often ask physicians to measure different pieces of patient care in a variety of ways. CAFP thus supports the Core Quality Measures Collaborative and its efforts to identify one set of measures that all payers will use. CAFP is fighting to ensure that the Primary Care measure set created by the Collaborative, is used in the Quality Payment Program and by California payers.


Questions about CAFP’s advocacy activities? Contact CAFP’s Director of Government Relations, Adam Francis.