STFM Writes to the President About the Effects the Executive Order on Immigration Has on Family Medicine Education and the Primary Care Workforce
February 3, 2017—Read the letter we sent to President Trump, addressing the workforce concerns we have regarding the immigration executive order. You may be aware that others in the family of family medicine and the wider medical community have submitted letters or statements as well, and may have covered areas we do not in our letter. We will continue to assess issues as they arise through the lens we describe above, and look forward to a very active advocacy effort in the coming months.
Contact Congress to Tell Them To Keep Primary Care Research and Training Provisions in the Affordable Care Act
January 19, 2017—Congress is considering fast-track repeal of the Affordable Care Act (ACA) through budget reconciliation. Last week, both the House and Senate passed reconciliation instructions for committees to repeal the ACA. Over the coming weeks, committees from both chambers will meet to determine the details of a repeal measure.
Follow this link to email your representatives. When you call your representatives, use the talking points below.
Talking Points and Phone Script
When calling your representative, use this phone script below to ask your representative to support primary care.
As a family medicine educator/researcher I am calling to ask your support of programs that support primary care medicine education and the patients we serve.
In addition to expanding health care coverage, there are other important provisions contained within the Affordable Care Act that specifically promote the primary care research and training infrastructure. The overall health of a population is directly linked to the strength of its primary health care system and workforce.
Teaching Health Centers: Successful program that awards grants to teaching health centers—community based ambulatory patient care centers—that operate a primary care residency program to support the expansion of primary care residency training in community-based ambulatory settings.
Title VII Primary Care Training and Enhancement: Reauthorized primary care medicine training under Title VII of the Public Health Service Act and included a new focus on Patient Centered Medical Homes.
Primary Care Extension Program: Established a Primary Care Extension program through the Agency for Healthcare Research and Quality (AHRQ) to support and assist primary care providers with the dissemination and implementation of innovations and best practices. Primary care research includes: translational science, organizing the health system to meet specific patient and population needs, evaluating best practices, and engaging patients, communities, and practices to improve health.
Medicare Graduate Medical Education (GME): Non-Hospital Training, Didactic Fix, and Closed Hospital Slot Distribution provisions modifies GME funding to count costs incurred at non-hospital settings, support use of volunteer preceptors, and provide a process for the redistribution of unused residency positions from closed hospitals.
PCORI: Authorized the Patient-Centered Outcomes Research Trust Fund–PCORI improves patient care and outcomes through patient-centered comparative clinical effectiveness research.
As Congress considers options related to health reform, I encourage you to maintain the small but important primary care training and research enhancements contained in the ACA and continue to support primary care training and research in any efforts to replace the ACA.
Contact Your Representatives to Cosponsor Teaching Health Center Resolution
September 28, 2016—Contact your representative to request they cosponsor H. Res. 899, expressing support for a stable and sustainable funding source for the Teaching Health Center Graduate Medical Education (THCGME) Program.
The purpose of the resolution, which does not have the force of law, is to help raise awareness the importance of the program and gain Congressional support for future strengthening of its funding.
The federal THCGME program has been an important and successful program growing from supporting 63 resident positions in the first year, to more than 700 in the 2016-2017 academic year. It directly addresses three major concerns regarding physician production: the serious shortage of primary care physicians in general, their geographic maldistribution, and the growing need for physicians who serve underserved populations. In addition, its accountability requirements serve as a model for other GME programs.
Download and personalize the
draft letter to your legislator (Word)
. We encourage you to contact your legislator using #CommunityGME to request their cosponsorship. Find your Legislators' Twitter handles
Contact Your Legislators to Support Funding for Primary Care Training Programs Under Title VII
August 18, 2016—Both the House and Senate Appropriations Committees have spending bills for Fiscal Year 2017. Each bill will need to be voted on by the House and Senate, respectively, and then a committee will have to resolve the differences between the two bills, which include a difference in total spending amount. Each bill provided current spending levels ($38.9 million) for the health professions primary care program line. (Title VII primary care training and enhancement program.) While it is good news that the program wasn’t cut, the work of the Committees and Leadership in reconciling the two bills may require reductions in some programs to fund increases in others.
In order to ensure they do not look to primary care training for additional funding, we ask that you contact your legislator to 1) thank them for including current levels for primary care training and 2) request that they ensure those levels continue or are increased as the reconciliation process moves forward.
: Click the link, and send a pre-written letter to your representative and Senators requesting their support. If you have any anecdotes or personal examples of the utility of the Title VII primary care grants, please add in a paragraph highlighting that information.
Contact Your Legislators to Keep AHRQ Alive
August 12, 2016—Contact your representatives and senators to request they support AHRQ and protect it from proposed cuts during conference between the House and Senate. Current proposed cuts—over $50 million in the House bill, $10 million in the Senate bill—are a continued attack on AHRQ. And if they go forward, important AHRQ programs will continue to be terminated. Click here to learn more about the issue and to contact your legislators
Contact Your Legislators to Cosponsor Community Hospital Bill
March 15, 2016—Contact your representative and senators to request they each cosponsor, respectively, HR 4732 and S 2671, ‘‘Advancing Medical Resident Training in Community Hospitals Act of 2016.’’ This legislation is supported by the family medicine organizations, the Association of American Medical Colleges AAMC) and various hospitals and hospital systems, to correct a small technical problem. It is not a larger GME reform bill.
The proposed legislation would make minor, technical adjustments to the current policy for new teaching hospitals to allow hospitals to host a small number of resident rotators for short durations without setting a permanent full-time equivalent (FTE) resident cap or a Per Resident Amount. This is not a fix for every hospital with the problem, but it is a fix that should help those fitting the characteristics below as well as allow hospitals in the future to host small numbers of rotating residents.
The legislation would benefit three groups of hospitals by:
- Group 1: Prospectively prohibiting the Centers for Medicare & Medicaid Services (CMS) from establishing an FTE cap or PRA for hospitals until they accept rotations of more than 1.0 resident FTE per year;
- Group 2: Providing a one-time opportunity to establish a new FTE cap and PRA for hospitals that inadvertently triggered an FTE cap between 1997 and the date of enactment by training no more than 3.0 resident FTEs in a cost reporting period from newly accredited residency training programs established by other institutions; and
- Group 3: Providing a one-time opportunity to establish a new FTE cap and PRA for hospitals that trained less than 1.0 FTE in the 1996 base year and thus have a resident cap of less than 1.0.
Download and personalize the draft letter to your legislator
(Word) and read the talking points
(PDF). We encourage you to contact your legislator using #CommunityGME to request their cosponsorship. View the list of Legislators' Twitter handles
How the President's Recommended Budget Would Affect Academic Family Medicine
February 12, 2016—The start to the Congressional appropriations season began with the release of the President’s recommended 2017 fiscal year budget (FY2017). As the eighth and final budget of President Obama, it included a list of things the President would like to accomplish before he leaves office. This budget outlines the Administration's ideas about where it wants to go with policy and what it sees as the needs for keeping the government running in an optimal way. Congress sets the actual spending by program and agency for the nation.
The budget calls for increased funding for opioid and other substance abuse and related mental health issues. The budget also has quite a few proposed new mandatory funding provisions. Mandatory funding is distinct from normal appropriations. These funds do not have to go through the annual appropriations process, but rather need the support of authorizing committees and passage into law, for the funding to take effect.
Items in the budget that affect academic family medicine which are funded by mandatory or discretionary appropriations are described below.
- Title VII primary care training—$38.9 million, which is the current level.
- AHECs were zeroed out again (but funded by Congress at $31 million last year)
- National Health Service Corps—funded at the current level of $310 million in mandatory spending for FY2017 (as included in MACRA), but then additionally proposes $20 million in discretionary spending and a further addition of $50 million in mandatory spending, earmarked for treatment of opioid use disorder and mental health initiatives. This would bring the total funding level to $380 million, in FY2017—a $70 million (22.6%) increase.
- Teaching Health Center GME—This year’s budget moved away from the President’s proposal of the previous 2 years to develop a competitive grant program, called Targeted GME. Funded by MACRA at $60 in mandatory funding for FY2017, the budget proposes $527 million in new mandatory funding in FYs 2018-2020. This would bring the total annual funding for THCs in future years to $175.6 million, rather than the current $60 million.
- Agency for Healthcare Policy and Research (AHRQ)—AHRQ’s FY 2017 budget includes a total program level of $470 million, which is $40 million above the FY2016 level. However, the discretionary spending amount equals $280 million, down $54 million from current levels of $334 million. This is due to mixture of an automatic increase in the Patient Centered Outcomes Research Trust Fund transfer, from $94 million in FY16 to $106 million in FY17, and an additional $83 million from the Public Health Service’s evaluation tap funding.
Moving from mandatory and discretionary appropriations to Medicare, the budget included extensive proposals related to physician and other provider payments. Among them would be a reinstitution of two programs from the Affordable Care Act that have expired, namely the primary care incentive payment, and the Medicaid payment parity provisions. The budget also included a provision almost identical to last year’s budget on Medicare GME Reductions. It would reduce funding for Indirect Graduate Medical Education (IME) payments by 10% over 10 years and give the Secretary the authority to set standards for teaching hospitals receiving Graduate Medical Education payments to encourage training of primary care residents and emphasize skills that promote high-quality and high-value health care.” This budget added new standards for “medication‐assisted treatment of substance use disorders” in the description.
President to Veto ACA Repeal Bill
January 7, 2016—Last night, the House approved the budget reconciliation bill that would repeal the Affordable Care Act (ACA) as well as block federal funding for Planned Parenthood for a year. This is the first time in the more than 60 votes since passage of the ACA that a repeal bill will become legislation to go to the President for signature. The vote is still largely symbolic at this time however as President Obama has already promised to veto the bill.
Congress Passes Omnibus Spending Bill
December 18, 2015—This morning both the House and Senate passed the omnibus spending bill. The more than $1 trillion spending package keeps the government running through September 2016. The White House has signalled that the President will sign it into law. Even with grumblings on both sides of the aisle regarding what was included in the bill and what was not, the majority of votes in both the House and Senate were in favor of the bill. The House passed the measure by a vote of 316-113; the Senate vote was 65-33.
Summary of the 2016 Fiscal Year Omnibus Spending Bill
December 16, 2015—Congress has proposed the following in its Omnibus spending bill for the 2016 fiscal year. This still has to be passed by Congress and approved by the President.
Stable funded Programs
Reductions in Funding
- Title VII Primary Care: funded at current levels - $38.9M
- AHECs: level funded at $21M
- Community Health Centers: stable discretionary funding at $1.49 billion (this is in addition to the mandatory appropriations of $3.6B, for a total of $5.2B, same as FY2015 levels.)
- Public Health and Preventive Medicine: stable at $21M.
- Geriatrics Education: $38.7M is allocated. This is an increase of $4.5M, but is really a transfer of the same amount from the Title VIII nursing program. Basically, all the HRSA geriatrics workforce programs are now bundled into one Geriatrics program line under the Interdisciplinary Community-based linkages programs – the same place that AHECs reside.
- Workforce Information and Analysis: $4.7M
is preserved at $334M—an almost $30M cut—much less than in the original Senate Committee bill and obviously not terminated as in the House bill. The agreement “expects AHRQ to focus its research on its traditional mission, such as improving patient safety and preventing healthcare associated infections.” It also includes additional support for investigator-initiated research – and stipulates that it “should not be targeted to any specific are of health services research so as to generate the best unsolicited ideas from the research community about a wide variety of topics.” It does not allow any of the discretionary appropriated funds to be used for patient-centered health research (AHRQ receives a transfer annually from the PCOR trust fund; the amount equals 20% of what is appropriated annually to PCOR. For FY2015 the amount equaled $105 m.)
- NIH: is increased to the level of the Senate recommendation, or an increase of $2B, to $32.084B. This includes $200M for the new Precision Medicine Initiative (PMI), and increase of $350M for Alzheimer’s research, and $85M for the BRAIN initiative. The Common Fund is supported with a set-aside within the Office of the Director at $675.6M (which includes the PMI funds.) $500M is directed to the Clinical and Translational Science Awards (CTSA) program, up $25.2M, to implement the recommendations of the 2013 IOM report on CTSA. In addition 1% of the NIH appropriations will go to HRSA for the awarding of National Research Service Awards (NRSA) grants for primary medical care to persons affiliated with entities who have received grants or contracts under Section 747 or 736 and 1% will go to AHRQ for the same purpose, but for health services research.
- Rural Health: an increase of $2.1M to $149.6M; this included an increase in rural outreach grants (paid for by a zeroing out of the community access to emergency devices,) and an increase in telehealth.
- Mental and Behavioral Health: an increase of $1M to $64.6M
- Children’s Graduate Medical Education (GME): up $30M to $295M
- Centers for Disease Control and Prevention: an increase of $1.1B to $7.2B in total program funding. This is made up of $6.3B in appropriations, almost $900,000 in transfers from the Prevention and Public Health Fund, and $15M from unobligated pandemic influenza funds from the Public Health and Social Services Emergency Fund (PHSSEF).
- Several tax provisions included in the Affordable Care Act (ACA) will be delayed. The ACA Cadillac health plan tax and the medical device tax are delayed for two years, until 2020, and a one year moratorium for in 2017 on a tax levied on all private health insurance is also included.
- Some of the appropriations riders related to abortion and Planned Parenthood have been dropped.
- The effort to repeal the ban on CDC firearm-related research was not included.
Congress Extends Funding Deadline
December 11, 2015—The House passed the 5-day extension of the continuing resolution today. President Obama is expected to sign the bill, which will keep the government running through Wednesday. This gives the Congress time to pass an omnibus spending bill for FY2016. The House version may be released to the public on Monday; how easily it will move forward will depend on what, if any, policy riders are included in it.
Congress Set to Extend Funding Deadline
December 11, 2015–Yesterday the Senate passed a 5-day extension of the current continuing resolution that expires today. The House is expected to vote on the extension today. The extension gives Congress and the President until midnight on December 16th to reach an agreement on a $1.1 trillion omnibus spending bill to keep the government funded through the end of fiscal year 2016.
Congress Expected to Miss the Funding Deadline
December 8, 2015—Congress is expected to miss the December 11 funding deadline for the FY2016 appropriations bill. Negotiations are slow and a great deal of major issues, not necessarily in the health arena, are still to be decided. Congress is also occupied with other major pieces of legislation including a tax-extender bill and a look at the visa waiver issue. Top Republican leadership has expressed support for a short term funding bill, rather than allowing a government shut-down. There is pressure to keep the temporary funding bill time period very short, no longer than a week, from the democrats.
President Vows to Veto Bill That Repeals Parts of ACA
December 4, 2015—The Senate passed a version of the House-passed reconciliation bill, HR 3762, Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015. Created by the Congressional Budget Act of 1974, reconciliation allows for expedited consideration of certain tax, spending, and debt limit legislation. The House bill, as revised in the Senate substitute, repeals extensive portions of the Affordable Care Act (ACA), including the individual and employer mandates, the medical device tax, and the “Cadillac plan” excise tax and includes the defunding of Planned Parenthood, among other issues. The House now needs to pass the updated Senate version. The President has stated he will veto any bill that comes to his desk if it repeals parts of the ACA.
Omnibus Spending Bill Negotiations Moving Forward—Hope for AHRQ Funding
December 3, 2015—Congress is crafting a 2016 Fiscal Year omnibus spending bill to fund the federal government until after the presidential election. CAFM staff and members worked through traditional letters to Congress as well as increased social media presence to make the case for continued support for the Agency for Healthcare Research and Quality. At risk is potential termination or drastic cuts to the agency's funding, which were incorporated in earlier versions of the House and Senate Committee bills. Congress has until December 11 to pass a spending bill to keep the government running. While a short-term stop-gap extension might occur, it is looking more likely that Congress will pass the bill before the end of the year, in part because this bill does not have controversial policy riders such as defunding Planned Parenthood or repealing ACA provisions.
Help Us Save AHRQ
November 12, 2015—Join the #SaveAHRQ Twitter campaign on Tuesday, November 17 to spread the message about why the Agency for Healthcare Research and Quality (AHRQ) is critical for improving health and health care in this country. Post messages to your Twitter account throughout the day on November 17 using the hashtag #SaveAHRQ. We encourage you to contact your Congress representative and tag them in your #SaveAHRQ tweets. View the list of Legislators' Twitter handles.
Ideas for Tweet content include:
- How you use AHRQ's research, tools, and datasets in your work
- Links to AHRQ studies of impact, news articles, op-eds, and blogs
- Messages about AHRQ's mission and vision
- Information about why health services and primary care research is such an important (and unique) component of the research continuum
Also join us on November 17, from 12–1 pm ET in
AcademyHealth’s Twitter Chat
. During this time, AcademyHealth will be asking questions about AHRQ and seeking responses from members of our community—in other words, the people who need AHRQ most. To join the Twitter chat, follow the #SaveAHRQ hashtag on Twitter and tweet with #SaveAHRQ to add your tweets to the conversation.
RFP for New Veterans Administration GME Positions Due August 15
The request for proposals from the Veterans Administration for new GME positions (FTEs) begining July 1, 2016, is now open. Deadline for submission of application is August 15. Applications must come from the VA facility with whom you are working to achieve new FTEs. Learn more
Tell Your Senators to Not Terminate AHRQ Funding
The Senate Labor/HHS Appropriations Subcommittee is expected to meet next week to mark-up the Senate version of the FY2016 Labor/HHS spending bill. The House Subcommittee-passed version of this bill terminates AHRQ. We need to make sure the Senate does not do something similar. Click on the Tell Your Senator Not to Cut AHRQ Funding
alert for instructions and Talking Points.
Tell Your Representatives ASAP to Not Terminate AHRQ Funding
Urgent help needed to prevent AHRQ termination! The House Labor/HHS FY16 appropriations bill terminates funding for the Agency for Healthcare Research and Quality (AHRQ.) We expect the full committee to meet as early as next week to complete work on the bill and report it to the Floor.
We need a member of the Committee to offer an amendment to restore funding for AHRQ, or for them to support such an amendment. At a minimum we need several members to speak up about the importance of AHRQ. If your member of Congress is a member of the
, click on the AHRQ Funding is in Jeopardy Action Alert
for instructions and Talking Points.
Ask Your Senators to Support the SGR Repeal
Congress is close to repealing the SGR. The bill to repeal it, the Medicare and Chip Reauthorization Act (HR 2), passed the House on March 26. It is now up to the Senate to take action on the bill. Click on the CAFM Action Alert
and ask your Senators to support HR 2 when the Senate reconvenes on April 13.
Contact Your Representatives to Ensure Funding of Important Programs
It is appropriations season on Capitol Hill. Members of Congress are making decisions about funding priorities for discretionary programs and agencies such as primary care training under Title VII and the Agency for Healthcare Research and Quality in FY2016. Now is the time to contact members about funding the importance of funding the programs. Read the three Advocacy Action Alerts
with talking points and other useful information to use when contacting Congress members.
Register for the Family Medicine Congressional Conference
Registration for the Family Medicine Congressional Conference is now open!
This conference is an exceptional opportunity to gain an understanding of federal advocacy, learn about current priorities for family medicine, and get practical, hands-on experience with the legislative process—all in 2 days. The early bird registration discount ends March 1.
Five New Faculty Members Awarded Scholarships to Attend the Family Medicine Congressional Conference
December 17, 2014—The Society of Teachers of Family Medicine has awarded scholarships for five new faculty members
to attend the Family Medicine Congressional Conference. Scholarship recipients were chosen based on their potential to be exceptional advocates and advocacy leaders within STFM and the broader academic family medicine community.
CAFM Needs You to Act Immediately to Make Sure Teaching Health Centers Don't Close
December 4, 2014—CAFM is asking its members to call US Representatives and Senators immediately and urge them to provide $63.7 million in additional funding for FY 2015 for Teaching Health Centers (THC). Without an additional $63.7 million in fiscal year 2015, THC Graduate Medical Education programs may have to shut down or downsize. To contact your congress person, read the CAFM alert
Family Medicine Organizations Ask Congress to Implement New Policies for GME Reform
September 15, 2014—The Council of Academic Family Medicine (CAFM) staff attended a hill briefing hosted by the American Academy of Family Physicians (AAFP) that detailed our new Graduate Medical Education (GME) policy recommendations. CAFM joined with AAFP in advocating for policies for increasing accountability and aligning resources in GME. Here is a message from the CAFM Presidents
detailing the new policy recommendations with additional resources to help understand our policies.
CAFM Advocates Receive IOM Report Talking Points
August 1, 2014—CAFM staff have published main findings and recommendations (PDF) of the recent Institute of Medicine report. The CAFM document includes points made by groups opposing the report’s conclusions and family medicine-related talking points that advocates can use when meeting with their legislators regarding GME reform. For information on the graduate medical education talking points, read the CAFM newsletter.
August CAFM Advocacy Network (CAN) Newsletter and Call to Action
August 1, 2014—Last week, CAN members received the latest CAFM newsletter
that included a call to action during the August recess. Members have been asked to contact their legislators and to advocate for GME reform.
Strengthen Your Advocacy Skills Through the New Faculty Scholarship
July 10, 2014—New faculty can apply for a scholarship to attend the Family Medicine Congressional Conference in Washington, DC May 12-13, 2015. Scholarship recipients will attain a better understanding of family medicine's legislative issues and learn how to inspire change at the national level. Applications are due October 6
More Than 200 Attendees at the Family Medicine Congressional Conference
April 12, 2014—The annual Family Medicine Congressional Conference was held April 7-8. More than 200 conference attendees visited congressional offices. Early feedback from the conference included many positive comments regarding the speakers, the information covered, and their congressional visits. Attendees are looking forward to returning next year where they will continue to speak and advocate for issues important to family medicine. Many live-tweeted their advocacy experience with the #FMCC2014 hashtag.
STFM Awards Scholarships to Attend the Family Medicine Congressional Conference
September 6, 2013—In 2013, STFM began a scholarship program for new faculty to enhance membership involvement and expertise in advocacy. Scholarship recipients are chosen based on their potential to be exceptional advocates and advocacy leaders within STFM and the broader academic family medicine community. The recipients of the 2014 New Faculty Scholarship are:
Tammy Chang, MD, MPH, MS, University of Michigan
- Nicholas Cohen, MD, University Hospitals Case Medical Center Family Medicine Residency, Cleveland, OH
- Elizabeth Menzel, MD, University of Wisconsin Fox Valley Family Medicine Residency, Appleton, WI
- Scott Nass, MD, MPA, Ventura Family Medicine Residency, Ventura, CA
- Santina Wheat, MD, MPH, Northwestern McGaw Medical Center, Erie Family Health Center, Chicago, IL
These scholarships cover the cost of attendance, travel, and meals for each recipient. Recipients will join conference attendees in learning about the legislative process, current priorities for family medicine, and how they can take action and interact with legislators and health care leaders.
Ask Congress to Highlight Title VII During the Program's 50th Anniversary
September 6, 2013—This month is the 50th anniversary of the establishment of Title VII. CAFM is encouraging key contacts to reach out to their Member of Congress and request that they give floor speeches to highlight the Title VII programs. (Title VIII for nursing is also celebrating this anniversary.) Personalize these sample floor speeches
with local district/state examples and send them to your Member of Congress. Be sure to email us
at and let us know of your efforts.
Schedule Local Congressional Visits with Your Representative
August 5, 2013—The August Congressional Recess is here, and we have some work to do. Please use the time in August when members of the House of Representatives are often home on their own turf, to set up an appointment with them, or invite them to visit your program or department. There are many ongoing issues of concern to academic family medicine, but one of our current concerns is gaining traction and support for our Medicare GME reform pilot legislation.
H.R. 487, the Primary Care Workforce Access Improvement Act of 2013 was introduced by Representative Cathy McMorris Rodgers (R-WA) on February 4, 2013 and currently has eight cosponsors. The more co-sponsors we gather the more likely our bill will become law. To find district contact information for your member and talking points please follow the
Take Action link and let us know of any action you take.