ACP calls for solutions to physician shortages, compensation

Key takeaways:

• ACP advocated for several policies at its Leadership Day event.
• The policies aim to increase the workforce, grant exceptions to step therapy protocols and address practice cost inflation.

The ACP held its annual leadership event May 14 and 15 in Washington, D.C., where members of the organization met with U.S. lawmakers to discuss their health policy priorities.

Some of the policies at the center of the advocacy event included issues within the physician workforce, physician compensation and step therapy protocols.

Rita K. Kuwahara, MD, MIH, a primary care internal medicine physician and Healio Primary Care Peer Perspective Board Member, discussed some of ACP’s top legislative priorities.

Physician shortages

As Healio previously reported, the number of primary care physicians per 100,000 people declined in the United States from 68.4 to 67.2 from 2012 to 2021, whereas the proportion of all clinicians in primary care remained at 28% from 2016 to 2021.

In response, ACP advocated for the Resident Physician Shortage Reduction Act of 2023 (H.R. 2389), which would increase the number of Medicare-supported graduate medical education programs by 2,000 positions a year for 7 years.

“I think that this act is incredibly important because we have a physician shortage that is getting worse in our country, especially for primary care physicians,” Kuwahara told Healio.

The number of medical schools that have opened in the U.S. has increased in recent years, she said. But the limited number of open residency positions “prevents us from enabling everyone who is interested in doing this work, particularly those passionate about practicing as physicians in primary care, to be able to train in residency positions in their home states and/or communities where they could be most impactful” Kuwahara said.

Budget neutrality

ACP also addressed the issue of budget neutrality within the Medicare physician fee schedule. Budget neutrality requires any increase in physician services to be paid for by “across-the-board reductions to all physician services,” according to ACP. This policy has resulted in annual physician pay cuts during the past several years.

The organization advocated for the Physician Fee Schedule Update and Improvements Act (H.R. 6545), which would raise the threshold for implementing budget-neutral payment cuts from $20 million to $53 million and provide an increased threshold update every 5 years based on the Medicare Economic Index.

The bill “would really address the issue of practice cost inflation that we’re currently seeing across the country,” Kuwahara said.

Step therapy protocol exceptions

Another policy priority is the Safe Step Act (H.R. 2630), which would reform step therapy — a price management practice that “requires patients to try and fail on lower-priced drugs selected by their insurer before the drug prescribed by their physician will be covered,” according to an ACP fact sheet.

Step therapy can lead to unnecessary administrative burdens, delays in care, exacerbation of current symptoms and negative health outcomes. The Safe Step Act would require group health insurers to grant exceptions to step therapy based on the following circumstances:

• if the patient previously tried and failed treatment with the required drug;
• if the required treatment is expected to delay the patient from receiving an effective treatment, leading to irreversible consequences;
• if the required treatment will harm the patient;
• if the required treatment will prevent the patient from going about their daily activities, including work; or
• if the patient is stable on their current treatment.

“This is a bill that really highlights ACP’s push to put patients before paperwork,” Kuwahara said.

Importance of advocacy

Kuwahara was invited to speak on ACP's 2024 Leadership Day Plenary Panel on "Sustaining Advocacy Around the Year," where she underlined the importance of advocating for health care solutions, pointing out that physicians “are privileged to have patients share their stories with us each day.”

“We have our fingers on the pulse of our communities and it is critical for us, as physicians, to ensure that our patients’ stories inform health policy. When patients cannot afford their medicines or have difficulty accessing care, these are health issues and should not be political issues,” she said. “We must use our positions of power to empower our patients and advocate for our patients and communities to address issues of health equity and improve health outcomes.”

References:

• Compensating physicians for the value of care. https://www.acpservices.org/sites/default/files/shared/documents/leadership-day/24/compensating-physicians-for-the-value-of-care-provided-2024-leavebehind.pdf. Accessed May 15, 2024.
• Leadership Day. https://www.acponline.org/advocacy/advocacy-in-action/leadership-day. Accessed May 14, 2024.
• Primary care and the physician workforce. https://www.acpservices.org/sites/default/files/shared/documents/leadership-day/24/primary-care-and-the-physician-workforce-ld-2024.pdf. Accessed May 15, 2024.
• Step therapy. https://www.acpservices.org/sites/default/files/shared/documents/leadership-day/24/step-therapy-issue-brief.pdf. Accessed May 15, 2024.