Acknowledging that the status quo in health care is unsustainable and that issues of access to coverage, quality of care and cost control must be addressed, and given legislative momentum in Congress, the Academy is advancing components for bills that protect patients and physicians. While reform discussions are still ongoing and no pending legislation is perfect, we are committed to continue collaborating with health leaders in Congress to improve bills being considered. The Academy is actively engaged with other physician organizations as health care reform legislation moves through the House and Senate.
The House Affordable Health Care for America Act was introduced Oct. 29. The Senate bill has been sent to the Congressional Budget Office to ascertain the total cost of the proposal. As the bills move forward, vast differences in how each chamber addresses health care reform have become apparent. The chart below dissects components in the bills that are important to the Academy and other physician organizations:
|Issue ||House Bill |
|Senate Finance Proposal |
|Physician Fee Fix (SGR) ||Calls for a permanent repeal of the sustainable growth fate (SGR) formula. Formula would be replaced with two “buckets.” First bucket would contain all E&M codes and would be updated each year at GDP plus 2%. Second bucket would contain all other codes and be updated at GDP plus 1%. After five years this system would be replaced by new payment methodologies designed to coordinate patient care. Ophthalmology will see a 2.4% to 4% increase in fees over the five-year period. ||Calls for a one-year fix of the SGR formula. The update would be +.5% for 2010. Physicians would then face a 25% or greater cut in 2011. There would also be a budget neutral 10% bonus payment to primary care physicians paid for by cuts in reimbursements to specialists of approximately .5% to .7%, leaving them with a zero or negative update. |
|Physician Value-Based Purchasing || || |
Physician Quality Reporting Initiative (PQRI)
|Reporting system remains voluntary with 2% bonuses for those reporting in 2010 and 2011. ||Reporting system becomes mandatory in 2012. Lowers bonus payments for reporting from 2% to 1% in 2010 and .5% in 2011. Imposes a 1.5% penalty in 2013 on providers who don’t report in 2012. For 2014 and beyond the penalty rises to 2% for failure to report. Allows some MOC activities to qualify physicians for the bonus. |
|Timely access to feedback reports and creation of an appeals mechanism. ||Penalties are imposed on providers who are outliers in their specialties. This penalty would apply to providers who are in the top 10% of their specialty in regards to resource use. |
|Independent Medicare Advisory Commission ||No provision. ||Sets up an independent commission with 15 members who are confirmed by the Senate. Beginning in 2015 the commission would be required to produce proposals that control Medicare spending by 1.5%. These proposals would receive an up-or-down vote as a single package. If Congress did not vote the package down or failed to act, the proposals would automatically go into effect. |
|“Shadow” RUC ||No provision. ||Provides an oversight board to review all decisions of the AMA’s Relative Value Scale Update Committee in order to review “overvalued” specialty codes. |
|Liability Reform ||Provides for state grants to test reforms at the state level. ||No provision. |
As the reform process moves forward, it is important for medicine to stay engaged and affect the final wording of any major health reform legislation. As important as are the “broad brushstrokes” of bill language, the details of bill language and final rules of implementation may well decide the legislation’s ultimate impact. We must continue to thwart inclusion of cost-control mechanisms such as an Indpenedent Medicare Advisory Commission, as well as implementation of untested reforms without input from medicine.