| Latest Senate Activities 12/09/09 — The Senate met over this past weekend to debate amendments to the "Patient Protection and Affordable Care Act." The most significant discussions occurred off the floor, where Senate leaders have been working to reach agreements on the most controversial issues, such as the public plan.
After six days of high-pressure negotiations, five Democratic liberals and five Democratic centrists reached a compromise on how to modify the public health insurance option in the bill (in the hope of gathering the necessary 60 votes). This proposal would create a new government-administered national insurance plan similar to the Federal Employees Health Benefit Program. In this national health plan, the Office of Personnel Management would be allowed to negotiate with private insurers who want to offer coverage to the uninsured and small businesses who participate in government-sponsored insurance exchanges.
The proposal was sent to the Congressional Budget Office (CBO) for scoring. Senate leadership hope to receive the CBO cost estimate by the end of this week.
The Heart Rhythm Society continues to review amendments and to follow the debate. We will share information with our membership on the proposals that are of greatest interest or concern for heart rhythm professionals, as appropriate. |
The Heart Rhythm Society, as a member of the Alliance of Specialty Medicine, was a signatory on a December 2, 2009 letter to United States Senate Majority Leader Harry Reid (D-NV). The letter expresses the Alliance's opposition to the Senate health care reform legislation, “The Patient Protection and Affordable Care Act,” now being debated on the Senate Floor. Read the full letter from the Alliance (PDF, 112K)
Quoted Highlights of the Letter
While the Alliance supports the need for health care reform, this opposition is the result of our concerns with several provisions impacting specialty care physicians. Among the provisions of concern:
Medicare Physician Payment Reform
Senate proposal: Current legislation would provide just a one year fix, replacing the 21.2 percent cut with a 0.5 percent positive update for 2010. Beginning in2011, the scheduled cuts would be implemented.
Alliance Comments: “Medicare’s sustainable growth rate (SGR) formula needs to be replaced with a permanent, stable mechanism for updating Medicare fees to continue to assure Medicare beneficiary access to high quality care. Rather than come back year after year, providing a short‐term fix to this large problem, we must stop utilizing band‐aid solutions and establish a new baseline for physician reimbursement.”
Valued-Based Payment Modifier
Senate Proposal: This provision would direct the Secretary of the U.S. Department of Health and Human Services (HHS) to develop and implement a budget-neutral payment system that would adjust Medicare physician payments based on the quality and cost of the care they deliver. Quality and cost measures would be risk-adjusted and geographically standardized. The Secretary would phase-in the new payment system over a tow year period beginning in 2015.
Alliance Comments: “While the Center for Medicare and Medicaid Services (CMS) has been testing various models in this area, CMS does not have the current capability to implement such a proposal and no valid methodology that incorporates appropriate risk adjustment factors and outcome measures even exists..."
"Rather than add stability to the physician payment mechanism, the proposal would create yet more instability with an unrealistic and unachievable timeline. CMS should be allowed to fully test models for value‐based payment and determine which system would achieve maximum benefit before further modification of a flawed Medicare physician payment formula. “
Payment Cuts for Specialty Care
Senate Proposal: Beginning in 2011, the provision would provide primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years. Half of the cost of the bonuses would be offset through an across-the-board reduction in all other services.
Alliance Comments: “While we understand the potential need to increase the payment rates of primary care physicians, many surgical and specialty medicine disciplines have faced significant cuts over the years while primary care fees have increased..."
"Specialists continue to lose more ground in the fees they receive for serving Medicare beneficiaries while their practice costs continue to steadily rise. This is particularly troubling because much of the funding for this health care reform proposal already relies on cuts to Medicare and to the physicians that provide those key services. Additional cuts will likely result in decreased patient access to critical health care services. With a shortfall of 49,000 surgeons and other specialists predicted by the year 2025, we can ill‐afford to further exacerbate the access to care problem.”
Independent Medicare Advisory Board (IMAB)
Senate Proposal: This provision would create an independent, 15-member Medicare Advisory Board tasked with presenting Congress with comprehensive proposals to reduce excess cost growth and improve quality of care for Medicare beneficiaries. In years when Medicare costs are projected to be unsustainable, the Board’s proposals will take effect unless Congress passes an alternative measure that achieves the same level of savings. Congress would be allowed to consider an alternative provision on a fast-track basis. The Board would be prohibited from making proposals that ration care, raise taxes or Part B premiums, or change Medicare benefit, eligibility, or cost-sharing standards.
Alliance Comments: “Congress should retain proper oversight of the process that determines how services are provided under Medicare and not relegate it to another entity..."
"“We certainly understand and appreciate concerns with the rising costs of health care. But this is not the way approach this problem. Rather than develop a coherent proposal to appropriately address the issue, the proposal contained in the substitute amendment abdicates Congress’ fundamental responsibility and instead hopes that others can develop additional solutions and then allows them to be implemented. If we go forward with this process, there will be myriad unintended consequences, including restricting access to important interventions and services for Medicare patients. You should not allow important health care decisions to be made with little clinical expertise, resources or oversight required to ensure that seniors are not placed in jeopardy.”
