In 2023, ACP made significant progress in advancing policies that benefit internal medicine physicians and their patients. Any policy win is the result of a number of contributing factors but driven by strong advocacy, including grassroots engagement. In August, the Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) announced a new value-based payment model designed to better support primary care physicians. The Making Care Primary (MCP) Model will launch in July 2024 in eight states and will include many features intended to facilitate an accessible on-ramp for primary care physicians who do not have prior experience in a value-based payment model. The MCP model includes elements designed to promote health equity, which ACP has long championed. It also adopts key elements that ACP proposed in the Medical Home Neighborhood model and aligns with recommendations in the ACP paper, Beyond the Referral: Principles of Effective, Ongoing Primary and Specialty Care Collaboration. One of our most impactful wins last year was securing the implementation of G2211 add-on code in the 2024 Medicare Physician Fee Schedule. Implementation of this code had been delayed for several years to help offset the cost of a previous physician payment fix during the COVID-19 pandemic. CMS included the G2211 code in the 2024 Physician Fee Schedule; however, the code was again targeted as a potential offset to help pay for a broader payment fix. ACP recognized the risk that the code might be delayed again and actively supported its implementation in multiple ways from the time the proposed fee schedule was released in July up through its implementation in January. As a result of our efforts, along with the work of our partners, the G2211 code can now be used to pay for the additional resources needed for patients who have serious conditions and support longitudinal relationships with patients. When used appropriately, the code can also offset about 90 percent of the across-the-board budget neutrality cut in the 2024 fee schedule. Success and progress in advancing policies that benefit internal medicine physicians and their patients is tied to the advocacy of ACP members and chapters. Our efforts to protect the implementation of the G2211 code were bolstered by the advocacy of ACP chapters and grassroots engagement from our members. Between August and December 2023, participants in the Advocates for Internal Medicine (AIM) Network sent 2,454 messages, including 265 individual comment letters to CMS, calling for code to be implemented without any further delay or disruption. Progress was also made in our efforts to reduce administrative burdens on physicians and remove barriers to care for patients. In January 2024, CMS released the Interoperability and Prior Authorization Final Rule. This rule, initially published for comment in early 2023, will enact several important reforms ACP has called for, including requirements for insurers to provide a specific reason for prior authorization denials and the establishment of time frames for responses to requests depending on urgency. Along with our partners, ACP spoke out repeatedly on the importance of finalizing this rule. After its proposal, ACP wrote to CMS supporting the proposed rule and suggesting potential improvements to some provisions. In December 2023, ACP wrote again to CMS to restate our support for the proposed rule and strongly urge it be finalized as soon as possible given its potential impact. ACP has also been advocating for Congress to enact legislation that would improve prior authorization processes and reform step therapy requirements. One of the legislative issues discussed with lawmakers at the 2023 Leadership Day, the College’s national grassroots lobby day in Washington, DC, was step therapy. Attendees asked their members of Congress to cosponsor the Safe Step Act (H.R. 2630/S. 652), legislation that would remove barriers to patient care and reduce administrative burden for physicians by reforming step therapy protocols. These efforts helped secure a 127% increase in cosponsorship of the House bill and a 7% increase in support for the Senate bill within a month of Leadership Day. Through Leadership Day last year, ACP members also helped build support for the Resident Education Deferred Interest (REDI) Act (H.R. 1202/S. 704), legislation that would authorize the interest-free deferral of student loan payment for anyone in a residency or fellowship program. Within one month of Leadership Day, cosponsorship of the REDI Act increased by 9.5% in the House and 50% in the Senate. While we have accomplished a great deal over the past year, much work remains. Advocacy continues, and is still needed, to secure sufficient support to advance prior authorization, step therapy, and student loan relief legislation. Additionally, as internal medicine physicians know well, systemic challenges in the Medicare Physician Fee Schedule remain and require Congressional action to fix them. You can learn more about our 2024 advocacy priorities here, along with opportunities for taking action. Together we have made meaningful progress on issues impacting internal medicine physicians and patients. With your continued advocacy this year, we have an opportunity to go farther.