March 19, 2010
Surgeons to Speaker: Senate Health Care Reform Bill Requires Significant Revisions
The Academy joined the American College of Surgeons and 21 other surgery and medical associations in expressing major changes that are needed to the Senate health care reform bill (H.R. 3590). The groups outlined issues that must be addressed in a letter to Speaker of the House Nancy Pelosi, D-Calif., including:

• Repeal of the sustainable growth rate and establishment of a fair and equitable Medicare physician payment system;
• Removal of a provision creating an independent Medicare cost-control commission;
• Maintaining voluntary participation in the Medicare physician quality reporting initiative (PQRI); and
• Implementation of medical liability reforms.

March 4, 2010
President Calls for Vote on Health Care Reform
President Obama has endorsed moving the Senate health care reform bill (H.R. 3590) forward using the budget-reconciliation process. Saying that he “believes that the Congress owes the American people a final vote on health care reform this year,” the president described a process where the House could vote on the Senate-passed bill, followed by a budget-reconciliation package that includes his changes and other needed modifications. In an effort to garner bipartisan support, the president endorsed inclusion of key Republican provisions in the reconciliation package. As a final step in this process, the Senate would then vote on the reconciliation package, with a simple majority (51 votes) needed for passage.

For medicine, the overarching issue is resolution of the sustainable growth rate (SGR). So far only short-term fixes (30 days, seven months or one year) are under discussion – none of which are acceptable to the Academy and others who are calling for a permanent solution to Medicare physician payment. Problems for medicine in the Senate bill include:

• Creation of a cost-control or advisory board directed to cut payments, primarily to physicians
• Penalties for not participating in the Medicare Physician Quality Reporting Initiative (PQRI)
• Non-discrimination language advocated by non-physicians

In a move to protect them politically, House Democrats are reportedly seeking a commitment/letter from 51 senators promising action on the reconciliation package before they vote to pass the Senate health care reform bill.

Jan. 21, 2010
Analysis: What the Massachusetts Election Means for Health Reform Legislation
With the recent special election in Massachusetts going to Republican state Sen. Scott Brown, Democrats lost their 60-vote majority in the Senate – effectively eliminating the option of simply passing a merger of House and Senate health care reform bills. Democratic leaders continue to work on resolving differences between the House and Senate bills and are regrouping to consider their options. No longer on the table is the option of the House passing the Senate bill (H.R. 3590), which would have avoided another Senate vote. Instead the White House has signaled the need for a scaled-back health care reform bill.

In addition, the Academy has been working with the American College of Surgeons and others to oppose the creation of a new Independent Medicare Payment Advisory Board (IMAB) in any health care reform bill (the Academy did not support the Senate’s H.R. 3590 because it included IMAB). This week, a letter signed by more than 118 members of Congress went to House Democratic leadership opposing inclusion of the IMAB in the final, merged health reform bill.

Congress shelving health care reform is unlikely, as the Democratic leadership is hurt more by failure to pass this major initiative than by passing something. As for Democrats concerned that the outcome of the Massachusetts Senate election was a referendum against the health care reform bill, most are already on record with votes in support of one of the bills.

Jan. 14, 2010
Health Reform is Top Priority when Congress Reconvenes
While a formal conference is unlikely, discussions to work out the differences between the respective House and Senate health care reform bills have already begun. The House reconvenes next week and the Senate on Jan. 20, but Democratic leaders met with White House officials this week about unresolved issues. The Academy and surgical leaders are waging a major campaign to ensure that the onerous independent payment advisory board (IPAB) in the Senate bill is not included in the final bill.

In the letter to Congress, groups representing beneficiaries and essentially all health sectors urge eliminating the board from the final bill. The groups object to the proposal’s use of fast-track legislative procedures and the cost that would be associated with making any changes to the board recommendations, and are concerned that this construct would create a body that is not accountable to anyone but the president.

The IPAB is just one of the components in the health care reform bills that the Academy and medicine are working to fix in the final legislation. In a conference call with the Academy and other medical leaders this week, the AMA laid out a target list of changes medicine seeks.

Dec. 21, 2009
Senate Proceeds Toward Final Vote on Health Care Reform Bill—Some Problematic Provisions Remain
With commitment for the required 60 votes, Senate majority leader Harry Reid, D-Nev., is moving toward final passage — maybe on Christmas Eve — on a revised health care reform bill (H.R. 3590) that was introduced Saturday. The bill offers some good news. In an accommodation to physicians, the Senate dropped:

• Medicare buy-in for 55-64 year olds;
• A cosmetic surgery tax;
• A Medicare enrollment fee for physicians; and
• A budget-neutrality requirement that balanced a bonus for primary care on the back of specialists.

Also dropped was a controversial amendment by Sen. Robert Byrd, D-W.Va., that promoted comprehensive eye exams for infants from six months to one year old performed by optometrists. Despite these positive steps, the Academy will not support the final Senate bill as many problematic provisions remain. The fight for a better bill for patients and physicians is far from over. As the Senate and House merge their health care reform bills over the next few weeks, the Academy will focus on efforts to eliminate the independent Medicare cost control commission and a mandatory quality reporting program for physicians. We will also fight a new provision that allows individual physician data to be made public in the Medicare Physician Compare program. >> More

Dec. 17, 2009
Medicine Encourages Implementation of Vision Care for Kids Act
The Academy has joined forces with several other groups to respond to a health care reform amendment by Sen. Robert Byrd, D-W.Va. The amendment would establish a national program to promote free, comprehensive eye exams by optometrists for infants between six and 12 months of age. The Academy and the American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Pediatrics, the American Academy of Family Physicians, the American Osteopathic Association and the American Association of Certified Orthoptists believe the amendment fails to follow evidence-based guidelines and would place an unnecessary burden on the health care system, when routine eye screenings by pediatricians and others in a medical home are in place.

A better approach to addressing the vision care needs of children would be to enact the Vision Care for Kids Act (S. 259). The bill would complement existing state efforts, providing $65 million in grants for eye examinations and follow-up treatment for children identified as having vision problems. S. 259 has broad support among the vision community and passed the House earlier this year, 404-17. We have urged Byrd and Senate leaders to forgo his amendment and instead work with the sponsors of S. 259, Sens. Christopher Dodd, D-Conn., and Kit Bond, R-Mo., to incorporate the Vision Care for Kids Act into the health reform legislation. Contact your senators and tell them to oppose comprehensive optometric vision and eye exams for infants and to support inclusion of S. 259 in the health care reform legislation being considered.

Dec. 10, 2009
Senate Continues to Modify Health Reform Bill, Could Vote Next Week
An effort to remove a public plan option — one of the biggest obstacles to passage of the health care reform bill in the Senate — has resulted in a new look at expanding coverage through a Medicare buy-in for 55- to 64-year-olds. This is a proposal that was rejected early in the development of legislation. With no permanent physician-payment fix in sight, medicine has rallied in unified opposition to this move. The AMA is calling on physicians to contact their senators (use the AMA hotline, 800.833.6354) to express opposition. The Academy continues to work with AMA, the American College of Surgeons, the American Society of Cataract and Refractive Surgery and others to find champions to amend the many problematic provisions for physicians.

Dec. 10, 2009
Optometric Infant Vision Exam Amendment Introduced in Senate Bill
A new wrinkle in the health care reform debate is an amendment by Sen. Robert Byrd, D-W. Va., that would establish a national program to promote free, comprehensive eye exams for infants between six and 12 months old. The amendment creates an initiative under the Maternal and Child Health Program to develop promotional and educational materials and engage optometrists to conduct the exams, which would be funded by public and private partnerships at the state and local levels. The Academy is concerned that the amendment fails to follow evidence-based guidelines and would place an unnecessary burden on the health care system when routine eye screenings by pediatricians and others in a medical home are in place. The Academy is working with the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics on a strategy to respond to this amendment.

Dec. 10, 2009
Academy Mobilizes Against Cosmetic Medical Procedures Tax
The Academy is working with a coalition of groups to oppose inclusion of a 5 percent tax on “cosmetic medical procedures” in the Senate health care reform bill. The excise tax uses the existing IRS definition of such procedures to determine whether a medical-related expense is deductible. Although LASIK and some ophthalmic plastic surgery is exempt, the proposed tax is bad public policy for many reasons, including:

• The proposed tax compromises patient safety by limiting the definition of "cosmetic medical procedures" to those performed "by a licensed medical professional." This establishes a tax loophole to avoid paying the tax by seeking elective cosmetic and medical procedures from non-medical personnel at salons, spas and other locations.
• The tax discriminates against working women, who are the largest consumers of cosmetic procedures.
• The abysmal failure of New Jersey's cosmetic-procedure tax demonstrates that this type of tax is an unreliable and risky revenue source.
• The elective surgery/medical procedure tax requires physicians to collect the tax and then holds physicians liable should an individual fail or refuse to pay the tax. Further, the Senate provision mandates implementation by Jan. 1, placing an incredible burden on physician offices to quickly begin collecting such taxes.
• These taxes provide U.S. cosmetic surgery patients with additional incentives to participate in "medical tourism" in countries that do not have the same patient safety safeguards that exist in the United States.

To join the Academy in opposing this tax, contact your senators.

Dec. 3, 2009
Senate Proceeds to Debate Health Care Bill: Inadequate Response to Medicine’s Concerns
While the Senate passed a procedural vote to begin debate of its health care reform bill (H.R. 3590) prior to Congress’ Thanksgiving recess, senators this week began debate on a bill that so far fails to address key concerns medicine has with the legislation. Besides the Senate’s failure to repeal the sustainable growth rate (SGR) and create a new Medicare payment system that is fair to medicine, H.R. 3590 (the vehicle the Senate is using to move its health reform bill) still includes an independent Medicare cost control board (renamed IMAB) that would leave physicians bearing the brunt of the $12 billion in proposed savings. While the Senate relented to some Academy and surgery demands, including dropping penalties for physician resource use outliers, many problematic provisions remain in H.R. 3590, including penalties for non-participation in Medicare’s Physician Quality Reporting Initiative, a bonus for primary care paid for by specialties, and a new 5 percent tax on cosmetic procedures. A comprehensive list of concerns that medicine has about H.R. 3590 is included in an AMA communication. The Academy is working with the AMA, the American College of Surgeons, the American Society of Cataract and Refractive Surgery and others to amend the legislation.

Nov. 19, 2009
Alert! House Passes SGR Repeal
Senate Introduces Troublesome Health Care Reform Bill
The House of Representatives this afternoon passed legislation (H.R. 3961) that repeals the sustainable growth rate (SGR) and creates a new Medicare payment system that is fair to medicine. Passage of H.R. 3961 was key to medicine’s negotiations on health care reform. The Academy supported H.R. 3961 and H.R. 3962 as "linked" bills. Thank you to members who contacted their representative in support of H.R. 3961. Senate consideration of an SGR repeal bill failed in October. Senate leadership now plans to revisit a permanent solution for physicians when health care reform is resolved.

The Senate yesterday finally introduced its health care reform bill (H.R. 3590). The Academy is reviewing that bill. Some adjustments have been made in response to the Academy and surgery’s demands including dropping penalties for physician use outliers, a provision that was unfair to specialists. However, many problematic provisions remain, including an independent Medicare cost control board (renamed IMAB). The Senate bill contains new problems, such as an unacceptable 5 percent tax on cosmetic procedures, including LASIK surgery. The tax would purportedly generate $5 billion over the next 10 years to help fund the Senate’s $849 billion plan. A vote on the “motion to proceed” is scheduled for Saturday evening. Then the Senate can proceed with a discussion on H.R. 3590, which will take place over several weeks.

Nov. 12, 2009
Alert! Tell Your Representative to Vote Next Week to Repeal the SGR
Key to medicine’s negotiations on health care reform has been the repeal of the sustainable growth rate (SGR) and creation of a new Medicare payment system that is fair to medicine. The House will vote next week on the Medicare Physician Payment Reform Act (H.R. 3961), which would permanently reform the Medicare physician payment system by repealing the SGR and providing physicians with the first Medical Economic Index update in seven years. The bill eliminates the accumulated debt and resulting cuts created by the SGR, including the 21 percent cut scheduled for Jan. 1. It creates a new physician payment formula with two “buckets”: the first bucket, which would contain all E&M codes, including eye codes, would be updated annually at a rate of GDP plus 2 percent; the second bucket, which would contain all other services, would be updated annually at a rate of GDP plus 1 percent. We estimate that this change would improve payments to ophthalmology by a minimum of 4 percent over the next five years, compared with current payments. Unlike the Senate bill considered earlier, the House bill includes positive updates for physicians. House moderates have agreed to exempt the cost of repealing the SGR from budget-offset rules that require cuts to offset any increase in outlays; therefore, H.R. 3961 is expected to draw bipartisan support.

Oct. 22, 2009
SGR Repeal Bill Fails in Senate
Stand-alone legislation (S. 1776) introduced by Sen. Debbie Stabenow, D-Mich., that would have wiped out the sustainable growth rate (SGR) failed yesterday in the Senate 47-53. Sixty votes were needed to pass the procedural vote. Senate Leader Harry Reid, D-Nev., said before the vote that if S. 1776 failed, the Senate would try for a multi-year physician payment fix after passage of health care reform legislation. With physicians facing a 21 percent Medicare cut on Jan. 1, he indicated that the Senate would keep the temporary one-year physician payment fix in its health care reform bill.

S. 1776 would have erased the 40 percent in cuts medicine faces today, including the 21 percent cut scheduled for Jan. 1. All physician groups (including the Academy) have long sought the repeal. Opponents of the measure objected to the bill because the costs of the repeal would immediately be applied to the deficit. Thirteen Democratic senators joined all Republican senators in voting against the SGR repeal.

Oct. 15, 2009
ALERT! Contact Your Senators and Tell Them to Support Repeal of the SGR
In an historic move, the Senate will vote on standalone legislation (S. 1776) introduced by Sen. Debbie Stabenow, D-Mich., that finally wipes out the sustainable growth rate (SGR). A repeal long sought by all physician groups (including the Academy), S. 1776 would erase the 40 percent in cuts medicine faces today, including the 21 percent cut scheduled for Jan. 1. This rebasing will allow medicine to advocate for a fair update from a no-debt position for the first time in eight years.

This is the first of a two-step process. First, eliminate the flawed SGR formula. Second, implement a new physician payment system with positive updates under health care reform. Both the House and Senate health care reform bills include positive updates for physicians. Supporting S. 1776 is not an endorsement of any health care reform bill that is under consideration at this time.

Passage of the SGR repeal bill is far from assured. Congress will have to vote to add the bill’s cost to the deficit, an issue for conservatives in both parties. We may not achieve the needed 60 votes for passage. The White House intends to pay for half the cost associated with eliminating the SGR by removing drugs from the equation.

Oct. 8, 2009
Senate Finance Committee Bill Bolstered by CBO Score
The problematic Senate Finance Committee health care reform bill has gained traction following the release of Congressional Budget Office (CBO) estimates that the bill would cost $829 billion over 10 years, well under the $900 billion threshold set by Finance Committee Chairman Max Baucus, D-Mont. The Academy and the rest of medicine remain frustrated with the bill, which continues to exempt hospitals from the onerous jurisdiction of the cost-cutting independent Medicare advisory commission. This would leave physicians bearing the brunt of the $12 billion in proposed savings that the commission would have to produce over five years. Other deal-breaker issues in the bill include:

• One-year sustainable growth rate fix for 2010, which leaves doctors facing a 25 percent payment cut in 2011;
• Calculation of physician payments based on a value index (quality divided by cost);
• 5 percent payment cut for physicians who are in the top 10th percentile of resource-use outliers;
• Penalties for non-participation in the Medicare Physician Quality Reporting Initiative (PQRI), beginning in 2011;
• Bonus for primary care balanced on the back of other specialties; and
• $350 "enrollment fee" charged to practitioners who want to participate in Medicare and Medicaid programs.

After the committee vote, which is scheduled for next Tuesday, the Finance Committee bill will be merged with the Senate Health, Education, Labor and Pensions Committee bill. Full Senate consideration of the unified bill is expected to begin Oct. 19. The Academy is working to make sure significant changes are made before this bill passes the Senate.

Oct. 1, 2009
Senate Finance Committee Moves to Exempt Hospitals from Cost-Cutting Commission; Physicians Left Holding the Bag
The Academy and other surgical specialties expressed outrage this week in a letter to Senate Finance Committee members regarding a decision to exempt hospitals from the new Medicare rate-setting commission that would be tasked with ensuring that spending is reduced by a minimum of 1.5 percent a year, beginning in 2014. Organized medicine has been vocal in opposition to such a commission, after experiencing five years of automatic cuts from the sustainable growth rate formula, due to spending targets being exceeded. Sen. Jay Rockefeller, D-W.Va., who first proposed the so-called independent Medicare advisory commission (IMAC), made modifications this week that would increase lawmakers’ power over the commission but the provision remains unacceptable to the Academy and other specialties. In addition, Finance Committee members agreed to remove the provision whereby the IMAC would expire in 2019, extending the term of the commission indefinitely (until Congress votes to eliminate it).

Hospitals gained the IMAC exemption by leveraging a deal made earlier with the White House and Finance Committee members, which cuts future hospital payments by nearly $150 billion. Currently hospitals receive “disproportionate share” payments from the government that reimburse them for uncompensated care burdens. The deal eliminates these payments in a phased-out manner, as more Americans become covered by health care insurance. The Senate IMAC provision is even worse than the one proposed in the House, which the Academy, along with the AMA and the American College of Surgeons, successfully defeated.