On February 8, Congress passed, and President Donald Trump signed, a budget deal that will fund the federal government through September 2019. The agreement increases domestic spending by about $128 billion over the next two years. Included in that amount is funding for the Children’s Health Insurance Program (CHIP), community health centers, and other programs affecting healthcare delivery and medical practices.
To get a better sense of what the budget deal will mean for doctors and the healthcare system, Medical Economics spoke with Robert Doherty, senior vice president for governmental affairs and public policy for the American College of Physicians (ACP.)
Medical Economics: In your view, what are the three or four biggest gains for doctors and healthcare to come out of this agreement?
Robert Doherty: Well I think they fall into several areas. One has to do with funding and re-authorizing several programs and priorities that were really up in the air until this bipartisan agreement was reached. That list included the Children’s Health Insurance Program, and that’s huge because there are about nine million children whose coverage was at risk had Congress not re-authorized CHIP. We came really close to the point where states were going to be forced to begin limiting enrollment in CHIP.
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There are several other programs whose authorizations were also set to expire. Community Health Centers probably top that list. Community Health Centers are the principal source of primary care in many underserved communities around the country. Their initial authorization lapsed on September 30 of last year. Congress patched together a very short-term extension for Community Health Centers to March but the budget agreement that passed Congress last week re-authorizes that program for two more years.
The same for National Service Corps. This agreement gives two years of funding for that program. And then there’s the Teaching Health Center GME Program, which is a pilot program to fund residency programs or teaching programs where physicians are trained in community health centers. That program’s authorization also lapsed and again there was a short-term extension but now that program is authorized for two more years.
So if you look at all those programs together, CHIP still provides coverage for millions of kids. The Community Health Centers and National Service Corps are extremely important programs in terms of providing access to primary in underserved communities. And the National Service Corps and the Teaching Health Center GME Programs are extremely important programs in terms of training physicians in fields like primary care. And again, the nice thing about it is it’s not just three or four months or even a year of authorization, they funded through fiscal year 2019.
There’s another change in the Medicare Quality Payment Program where there’s a cost of care [category] of MIPS that originally was going to be 10 percent of the physician’s score under MIPS. And CMS delayed implementing that, so that for the last two years that component has been zero percent of your total score. But under the MACRA law that was going to go to 30 percent [in 2019], but Congress included in the budget agreement flexibility for the administration to not go above 10 percent with that.
So that could be significant because CMS does not have a good way of measuring cost of care and if it had gone to 30 percent, that would have been a big part of the MIPS scores for something that’s not reliable and probably would have put quite a few physicians in negative territory in terms of updates based on the cost of care measure.