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Hello,
Weekly
Healthcare Reform Update
As
Congress returns from its August recess, Washington’s focus is squarely on
healthcare reform legislation. Weeks of contentious meetings with
constituents who are confused and frustrated by the complexities of reform
and the impact of the unknown have clouded the next steps.
Three
House committees – Ways and Means, Energy and Commerce, and Education and
Labor – have approved somewhat different versions of the same healthcare
reform legislation (H.R. 3200). Democratic leaders are expected to spend
the next few weeks meeting with House members to forge the three bills into
one consolidated piece of legislation to take to the House floor for a
vote.
Over in
the Senate, the news this week was the release of an 18-page “Reform Framework”
by Finance Committee Chair Sen. Max Baucus, (D-MT). The Chairman continues
to work with a six-member bipartisan group of Finance Committee members in
an attempt to craft a consensus bill. According to the Chairman the
framework reflects “the group’s conversations and the group’s work
throughout the summer, including throughout the August recess.”
Proposals
in the framework that should interest those in medical group practices
would:
- Replace the
scheduled 21.5 percent reduction in 2010 Medicare physician payments
with a 0.5 percent increase (unlike the House bill, however, it would
not repeal the sustainable-growth-rate formula and stop scheduled
payment cuts beyond 2010);
- Require that
all eligible health professionals participate in Medicare’s Physician
Quality Reporting Initiative by 2011;
- Create a 10
percent bonus payment to primary care and general surgery providers
who practice in health professional shortage areas. Funding for this
bonus is offset by reducing payments for all other services by 0.5
percent;
- Establish
payment incentives for physicians if they are deemed to appropriately
order high-cost imaging services;
- Increase the
imaging utilization-rate assumption for advanced imaging equipment
from 50 percent to 90 percent, which will result in lower
practice-expense payments for the technical component of services
using this equipment;
- Simplify
administration by “accelerating the development, adoption and
implementation of standard, consensus-based operating rules for four
HIPAA* transactions: eligibility verification, claims status,
payment/electronic funds transfer and remittance advice”;
- Expand the
Medicare physician feedback program and penalize physicians who use
significantly more resources than their peers;
- Allow groups
of providers to form accountable care organizations, improve quality
of care and share in half of the savings achieved over a three-year
period;
- Require all
individuals to have health insurance by 2013;
- Require all
employers with more than 50 full-time employees to pay a fee if they
don’t offer health insurance;
- Create the
Consumer Operated and Oriented Plan (CO-OP), comprising “nonprofit,
member-run health insurance companies”; and
- Establish
state-based health insurance exchanges.
President
Obama addressed a joint session of Congress on Wednesday evening and
emphasized the areas of agreement between Democrats and Republicans. In
addition to outlining his plan,
the president announced he was directing the secretary of Health and Human
Services to begin work immediately to offer state demonstration grants on alternative
medical-liability reforms. MGMA will continue its work
with medical specialties to advocate that meaningful liability
reform is included in any final reform legislation.
What
might be next? After repeated delays, Sen. Baucus has indicated his
intention to introduce legislation next week and proceed to consideration
of the legislation by the Senate Finance Committee during the week of Sept.
21.
For a
copy of the recent Senate Reform Framework, legislative
proposals, MGMA letters and other comments on healthcare reform, visit
the MGMA
Healthcare Reform Resource Center.
*Health
Insurance Portability and Accountability Act
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September 11, 2009
Member Resources
Healthcare Reform Resource Center
Medicare Provider Enrollment Toolkit
Red Flags Rule Resource Center
Recovery Audit Contractors Resource Center
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