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Hello,
Weekly Healthcare Reform Update
Senate
Finance chairman introduces committee starting point
The
major news of the week in Washington was the long-awaited introduction of
draft healthcare reform legislation by the chairman of the Senate Finance
Committee, Max Baucus, D-Mont. This is the most detailed information to
date, and it will serve as the starting point for formal consideration of
legislation the week of Sept. 21 by all members of the Finance Committee.
The
legislation, known as "America’s Healthy Future Act of 2009,"
will be subject to numerous amendments by both Democratic and Republican
members of the Senate Finance Committee. They will then decide whether to
approve a Finance Committee version of healthcare reform. If that happens,
it will be combined with the previously approved Senate Health, Education,
Labor and Pensions (HELP) bill to produce one piece of legislation ready
for consideration by the full Senate.
Although
Sen. Baucus worked over the past year to produce a bipartisan bill, none of
the three Republican senators in the so-called "Gang of Six"
(Olympia Snowe of Michigan, Chuck Grassley of Iowa and Mike Enzi of
Wyoming) endorsed the chairman’s proposal. Baucus stated that he believed
his effort would eventually garner Republican support and indicated that
this proposal was only a starting point that would undergo changes
before the committee’s consideration tentatively scheduled for
Tuesday, Sept 22.
While
MGMA believes it is important for the legislative process to progress, we
have significant concerns about many provisions. Those of interest to MGMA
members include:
- Replacing
the scheduled 21.5 percent reduction in 2010 Medicare physician
payments with a 0.5 percent increase;
- Requiring
that all eligible health professionals participate in Medicare’s
Physician Quality Reporting Initiative by 2011;
- Creating a
10 percent bonus payment for primary-care and general-surgery
providers who practice in health professional shortage areas. Funding
for this five-year bonus, to start in 2011, is offset by reducing
payments for all other services;
- Establishing
the CMS Innovation Center, which would be required to test and
evaluate patient-centered delivery and payment models, including
payment incentives for physicians if they are deemed to appropriately
order high-cost imaging services. The center would be exempt from
budget-neutrality requirements for an initial testing period and would
be required to consult outside experts and stakeholders;
- Increasing
the imaging utilization rate assumption for advanced imaging equipment
from 50 percent to 65 percent for 2010 through 2013, which will result
in lower practice-expense payments for the technical component of
services using this equipment;
- Creating a
nonelected Medicare Commission to develop and submit proposals to
Congress that extend Medicare solvency;
- Simplifying
healthcare 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";
- Expanding
the Medicare physician feedback program in 2012 and, beginning in
2015, reduce payment by 5 percent if an aggregation of a physician’s
resource use is at or above the 90th percentile of national
utilization;
- Allowing
groups of providers, beginning 2012, to form accountable care
organizations, improve quality of care and share in half of the
savings achieved over a three-year period;
- Requiring
all individuals to obtain health insurance by 2013;
- Requiring
all employers with more than 50 full-time employees to pay a fee if
they don’t offer health insurance, beginning in 2013;
- Creating, no
later than 2012 and expiring at the end of 2015, the Consumer Operated
and Oriented Plan (CO-OP), comprising "nonprofit, member-run
health insurance companies";
- Establishing
state-based health insurance exchanges beginning in 2010; and
- Providing
assistance to Medicare Part D beneficiaries when they reach the
"doughnut hole" in benefit coverage.
Meanwhile,
over in the House, Democratic members continue an internal debate over
whether to move forward with consideration of their healthcare bill on the
House floor or obtain a better assessment of the work product resulting
from the Senate Finance Committee’s deliberations. Democratic House members
are also conducting subject-specific seminars to gauge their members’
support for competing provisions to include in their final product.
Next
week
– Senate Finance Committee members are scheduled to consider amendments to
Sen. Baucus’ proposed legislation as they attempt to approve their version
of healthcare reform. The next step in moving the committee process toward
floor consideration by both the House and Senate may finish by the end of
next week.
*Health
Insurance Portability and Accountability Act
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Sept.18, 2009
Member Resources
Healthcare Reform Resource Center
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Red Flags Rule Resource Center
Recovery Audit Contractors Resource Center
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