Congress has taken its traditional August recess and while Senators and Representatives are home they need to hear from you. This is an excellent opportunity to interact with your Member of Congress and express your concerns or emphasize the ideas you like in health care reform. Many legislators hold meetings that are open to the public; to find out when a town hall will be held near you, download the Society's Health Care Town Hall spreadsheet (Microsoft Excel file, 120K). If you do not have Excel installed on your computer, visit the Microsoft website to download a free viewer. For information on who represents you in Congress, visit the Society’s Legislation Action center.
House of Representatives Summary
On July 14, 2009 the “American’s Affordable Health Choices Act” was introduced in the U.S. House of Representatives. Immediately following introduction, all committees of jurisdiction began their mark up. The Ways and Means Committee and the Education and Labor Committee both voted out a bill on July 17 with some differences as a result of amendments added during the mark-up process. The Energy and Commerce Committee delayed the mark-up to allow Henry Waxman (D-CA), chairman of the Committee, to negotiate with the conservative Blue Dog Democrats. The Energy and Commerce Committee marked up the legislation on July 30-31 and passed the legislation by a vote of 31-28 on July 31. Five democrats joined the Committee Republicans in voting against the bill.
Among the issues affecting physicians:
Physician Payment Update:
The proposed legislation would replace the 21.5 percent fee schedule reduction in 2010 with an update of 1 to 1.5 percent. Beginning in 2011, the flawed Sustainable Growth Rate (SGR) formula would be replaced, grouping services into two categories andestablishing separate target growth rates:
- Category One: Evaluation and management services (including office visits, primary care services, emergency services, consultation and home services), primary care and preventive services). These services will be reimbursed based on the gross domestic product (GDP) +2 percentage points
- Category Two: All other services will increase based on the GDP + 1 percentage point
Potentially Misvalued Codes:
The legislation would also give authority to the Secretary of the U.S. Department of Health and Human Services (HHS) to periodically review potentially misvalued services, such as those with fastest growth, codes that have experienced changes in practice expenses, codes for new technologies, codes that are often billed together or codes that have not been subject to review since the implementation of the Resource Based Relative Value System (i.e., Harvard-valued codes). The Secretary would be entitled to use the existing structure, such as the American Medical Association/Specialty Society Resource-Based Relative Value Scale (RVS) Update Committee, or can choose to create its own process to receive recommendations on the review and appropriate adjustment of potentially misvalued services.
Public Plan:
This legislation proposes the creation of a public plan option which will be self-sustaining and will comply with the same rule as the private insurers. The Secretary will establish payment rates for the public health insurance option. The payment rate would be at a "similar" rate as Medicare. If providers are currently serving Medicare patients, they will be automatically enrolled into the public plan. However, they have the opportunity to opt-out of the plan. In order to encourage participation, the legislation would provide a 5 percent bonus for the first three years to providers who participate in both Medicare and the public plan option.
Comparative Effectiveness Research (CER):
This legislation proposes the establishment of the “Center for Comparative Effectiveness Research” within the Agency for Healthcare Research and Quality (AHRQ), which will conduct, support and synthesize research with respect to outcomes effectiveness and appropriateness of health care services and procedures.
Two amendments were approved for the CER Research provision. The first amendment would prohibit the use of federal monies by CMS to fund CER for the purpose of making coverage determination for medical treatments. The second amendment would prohibit the use of CER research to deny or ration medical care.
Physician Sunshine Act:
This provision would mandate that pharmaceutical and medical device companies publicly report all money or gifts given to covered recipients. Examples of such money or gifts include consulting fees, compensation for services other than consulting, honoraria, entertainment, food, travel, education, research and charitable contributions. In this bill, covered recipients include physicians, physician group practices, pharmacy, pharmacy benefit managers, hospitals, medical schools, sponsors of continuing medical education, patient advocacy, health care professional organizations and biomedical researchers. This legislation includes limited state pre-emption language.
Next Steps, House
The next step is the reconciliation of the three versions of the House bill into one bill. House leaders intend to work during the August recess to reconcile the differences among the Energy and Commerce Bill, the Ways and Means bill and the Education and Labor bill, and bring a single bill to the House floor for vote in September.
Senate Summary
In the Senate, the Health, Education, Labor & Pensions (HELP) Committee voted out its health care reform bill by a party line vote on July 15. No Proposal has been released from the Senate Finance Committee. Over the last few weeks, the "Gang of Six" (composed of Senators Max Baucus (D-MT), Charles Grassley (R-IA), Kent Conrad (D-ND), Mike Enzi (R-WY), Jeff Bingaman (D-NM), and Olympia Snowe (R-ME)) has been meeting behind closed doors negotiating a bi-partisan legislation. Proposals rumored to be under discussion that would afftect physicians include:
Physician Payment Reform:
One-year fix to the Medicare physician payment Formula and a 10 percent bonus to primary care physician — where 5 percent of this bonus will be budget neutral — taking from the specialty doctors under the SGR expenditure target formula.
Public Plan:
The Senate Finance Committee is not considering a public plan as an option for health care. The Committee favors a health care cooperative, which was proposed by Senator Kent Conrad (D-ND) in June, i.e., “non-profit, non-government” health plans in which the government sets certain standards.
Physician Quality Reporting Initiative:
The Senate Finance Committee is considering a punitve approach to physicians participating in the Physician Quality Reporting Initiative (PQRI). Beginning in a particular year, Medicare physician payments would be reduced (e.g., 1-2 percent) to any physicians not reporting performance measures under PQRI.
Independent Commission:
The Senate Finance Committee is considering creating an independent commission (such as Medicare Payment Advisory Commission aka MedPAC) to make Medicare payment policy decisions. This proposal would allow MedPAC’s reimbursement and cost reduction recommendations to be implemented unless opposed by a joint resolution of the Congress.
Contact Your Legislator
As noted, many lawmakers will be in their district during the month of August talking about health care reform at town halls or similar type of events. Please take advantage of this opportunity to interact with them on the topic of health care reform. To find out when a town hall will be held near you, download the Society's Health Care Town Hall spreadsheet (Microsoft Excel file, 120K).
