The Patient Protection and Affordable Care Act (PPACA) is a work in progress. Many PPACA provisions must be implemented by federal regulatory bodies and state governments, which are given a great deal of latitude. CAFP is working hard to maximize the potential benefits of PPACA for family physicians and their patients.

• PPACA provided general guidelines for many reforms, but the specifics will be determined through regulations that will be issued over the next several years. The regulatory process often involves a "public comment" period that allows CAFP to provide input to regulators and advocate for family physicians and their patients. For example, CAFP submitted comments to the Centers for Medicare and Medicaid Services (CMS) on draft regulations that would change the 2011 Physician Fee Schedule. CAFP urged CMS to broaden the codes that will be included in the definition of "primary care services" to ensure that all family physicians (especially those in rural areas who provide a wide variety of health care services) will receive bonus payments created by PPACA.

• CAFP will ensure that California family physician leaders are at the table when health reform policies are crafted. PPACA established a National Health Care Workforce Commission to recommend and implement actions to address the health care workforce shortage facing the country. The Commission will examine the barriers to entering and remaining in primary care careers and will formulate possible solutions. CAFP nominated Kevin Grumbach, MD and Joseph Scherger, MD, MPH for this Commission and they are now under consideration by the federal government. Appointments are expected before September 30, 2010.

• CAFP is actively seeking pilot and demonstration project opportunities to test new models of care, such as the Patient Centered Medical Home. CAFP spearheaded a coalition of providers, patient advocates, and community leaders urging the State of California to submit a Letter of Intent to CMS's Multi-Payer Advanced Primary Care Practice Demonstration Project, although the State declined to do so. CAFP is also working to encourage project development in Fresno and San Diego in anticipation of potential funding opportunities to improve access to family medicine and primary care.

• CAFP is working to ensure that provisions that further primary care payment reform in PPACA come to fruition. It will require advocacy from CAFP and all family physicians to ensure that alternative payment mechanisms adopted by potential Accountable Care Organizations and the CMS Innovation Center pay for ALL the work done by family physicians, including care management and coordination, and reduce the payment gap between primary care physicians and subspecialists. We will work to ensure that new payment mechanisms in pilots and demonstration projects increase pay for preventive and comprehensive care, and reward family physicians for high quality care.