For Doctors, It’s the SGR: The Policy & Practice Podcast

The Super Committee — officially known as the Joint Select Committee on Deficit Reduction — sat down together officially for the first time last week. With their tight deadline and daunting task, some experts are expressing concern that Super Committee efforts will address the Sustainable Growth Rate formula.

In other SGR news, MedPAC commissioners heard one proposal on how to fix the SGR. While the proposal would lop $100 billion off the price tag for a fix, doctors of many stripes were not pleased with how the savings would be accomplished.

Courtesy Flickr/DonkeyHotey/Creative Commons

Also, a new report from the Census Bureau showed that nearly 100 million more  Americans were uninsured in 2010. However, 18- to 24-year-olds gained coverage. Census officials say that could be because of  provisions in the new health law that keep young people insured through age 26.

For more details, listen to this week’s Policy & Practice Podcast.

Stay tuned next week for an update on Super Committee talks and a debate on what constitutes a “grandfathered” health plan.

—Frances Correa (@FMCReporting)

Here Comes the Super Committee

The Joint Select Committee on Deficit Reduction was created as a part of Congress’ debt deal in July. The 12-member bipartisan committee is charged with cutting $1.5 trillion in federal spending by Thanksgiving. Medicare and Medicaid benefits, doctor’s pay, and the Children’s Health Insurance Plan could be on the chopping block. As physicians advocate for a permanent fix to the Sustainable Growth Rate Formula and medical liability reform(among other things), here’s a look at what you can expect from committee members concerning the issues that matter to you.

Co-Chair: Senator Patty Murray (D-Wash.)

Courtesy Sen. Murray

As a supporter of the Affordable Care Act (ACA), Sen. Murray (@SenMurrayPress) advocates for expanding access to health care, including increasing mental health coverage and the use of health technology. She also supports decreasing long-term health costs through preventive care.

She has experience in handling budget and spending issues after serving on the Senate Budget Committee and the Appropriations Committee. She is currently the chair of the Appropriations Subcommittee on Transportation. Click here to learn more.

Health-related legislation: Sen. Murray has sponsored several health-related bills including legislation to increase awareness of emergency contraception, and a bill to improve mental health services for the military.

Co-chair: Rep. Jeb Hensarling (R-Tex.)

Courtesy Rep. Hensarling

Rep. Hensarling (@RepHensarling)  has a background in economics and previously served on the Congressional Oversight Panel for the Troubled Asset Relief Program (TARP) and on the President’s Debt Commission.

Rep. Hensarling has maintained a conservative voting record and opposed the ACA, calling it a “travesty.” He advocates for limited government, including arguing against the expansion of Medicare, Medicaid, and Social Security. He currently serves as the chairman of the House Republican Conference and as vice-chairman of the House Financial Services Committee. Click here to learn more.

Health-related legislation: Sen. Harling has cosponsored legislation to repeal the ACA (H.R. 4903, H.R.4919,  and H.R.4972). He has also cosponsored H.R. 3217, to allow Americans to purchase health insurance across state lines, and H.R. 1086 to enact medical liability reform.

Other members of the Joint Select Committee on Deficit Reduction include:

Sen. Max Baucus (D-Mont.)

Courtesy Sen. Baucus

A long-time supporter of the ACA, Sen. Baucus (@MaxedBaucus) supports expanding Medicaid and Medicare benefits, increasing preventive services, and closing the prescription drug coverage gap under Medicare Part D. He also supports programs to provide access to health care for displaced workers, farmers, and ranchers. He has advocated to increase funding for the Children’s Health Insurance Program (CHIP) and is the chairman of the Senate Finance Committee. Click here to learn more.

Sen. John Kerry (D-Mass.)

Courtesy Sen. Kerry

Sen. Kerry (@JohnKerry) has been a steady advocate for expanding health coverage for children. He has also been behind legislation to improve funding for hospitals as well as consumer protection in the Medigap marketplace. A supporter of the ACA, Sen. Kerry also has worked to improve and expand access to health care in his own state, which functions under a single-payer system. In 2010, Sen. Kerry worked to provide incentives for small businesses to offer health insurance for their workers. He is chairman of the Senate Foreign Relations Committee. Click here to learn more.

Sen. Jon Kyl (R-Ariz.)

Courtesy Sen. Kyl

Sen. Kyl (@SenJonKyl) supports repealing the ACA, maintaining the belief that the law takes decision-making away from physicians and patients and puts it in the hands of the government. He also advocates for medical liability reform, the purchase of health insurance across state lines, and expanding coverage through improving the system of health spending and flexible spending accounts. He currently serves on the Senate Finance Committee. Click here for more on his preferred approach to health care reform.

Sen. Pat Toomey (R-Pa.)

Courtesy Sen. Toomey

Sen. Toomey (@SenToomey) cosponsored the bill the repeal the ACA. In an op-ed piece, Sen. Toomey voiced support for individuals purchasing health insurance, as opposed to an employer-based system, as well as purchasing coverage across state lines. He also supports the need for medial liability reform and federal regulations to allow small businesses and organizations to purchase health insurance on behalf of their members. He sees this as a path to decreasing costs and increasing competition. Click here to learn more.

Sen. Rob Portman (R-Ohio)

Courtesy of Sen. Portman

Sen. Portman (@robportman) does not support the ACA. He argues that the health care law increases costs for employers, making it more difficult for them to hire workers. Sen. Portman has voiced his support for expanding health savings accounts, purchasing health insurance across state lines, implementing tort reform, and encouraging medical innovation. Click here to learn more.

Rep. Xavier Becerra (D-Calif.)

Courtesy Rep. Becerra

Rep. Becerra (@RepBecerra) has spoken out in ardent support of the ACA, calling it “transformative.” He has advocated for the expansion of Medicare, Medicaid, and CHIP. In 2010, Rep. Becerra was recognized by the California Hospital Association as  a “health care champion” for his work to preserve $3 billion in Medicare funds  for hospitals in California.  Click here to learn more.

Rep. Dave Camp (R-Mich.)

Courtesy Rep. Camp

Rep. Camp (@RepDaveCamp) is the chairman of the House Ways and Means Committee. He was the first to introduce a bill to repeal the ACA, although he has supported certain aspects of the law including providing affordable coverage for individuals with pre-existing conditions.   Rep. Camp submitted his own alternative to the health care law, which he says will lower to cost of care without raising taxes or cutting Medicare. Click here to learn more.

Rep. Jim Clyburn (D-S.C.)

Courtesy Rep. Clyburn

Rep. Clyburn (@Clyburn) was one of the main advocates for the passage of the ACA. He previously voted against capping damages in medical liability suits. Rep. Clyburn  also supports the expansion of Medicare, Medicaid, and CHIP, as well as negotiating prices for prescription drugs covered under Medicare Part D. Click here to learn more.

Rep. Fred Upton (R-Mich.)

Courtesy Rep. Upton

Rep. Upton (@RepFredUpton) advocates for repealing the ACA, expanding health savings accounts, allowing the purchase of coverage across state lines, and implementing medical liability reform. He has also spoken out against the Independent Payment Advisory Board (IPAB), an 15-person appointed board that will be tasked with reducing costs to Medicare, without affecting quality or coverage. IPAB opponents say it could take aim at reimbursements to health professionals, who already face a 30% pay cut in January. Rep. Upton serves as chairman of the House Committee on Energy and Commerce.

Rep. Chris Van Hollen (D-Md.)

Courtesy Rep. Van Hollen

Rep. Van Hollen (@ChrisVanHollen)  supports the IPAB, saying it is a tool that ensures the solvency of Medicare. He has also argued against raising the age Medicare eligibility. In a recent interview with National Public Radio, Rep. Van Hollen said the government should improve incentives for doctors and hospitals to provide quality care. Rep. Van Hollen serves as ranking member of the House Budget Committee. Click here to learn more.

–Frances Correa (@FMCReporting on Twitter)

Research for this article was gathered from the following sources: govtrack.com, PRNewswire, Senate websites, House websites, politifact.com, ohiogop.com, ontheissues.org, politico.com, and npr.org

Time to Bundle: The Policy & Practice Podcast

Federal health officials are looking for providers to test new bundled payment models under Medicare. With four options for bundling, the government is hoping to appeal to a wide range of health providers. So far, the American Medical Association has praised the model for its flexibility.

Courtesy C-SPAN

In other news, the Congressional Budget Office released its summer report and is warning lawmakers to make drastic cuts or face the grim prospect of skyrocketing budget deficits.

Meanwhile, the Commonwealth Fund released a report showing that a majority of Americans who’ve lost their jobs in the recession are going without needed medical care. Although the Obama administration is disputing the findings, the fund recommends extending jobless benefits.

For more on that, listen to this week’s Policy & Practice podcast:

Check back next week for details on the first steps of Congress’ deficit-reduction super committee.

—Frances Correa (@FMCReporting on Twitter)

Docs Brace for Cuts: The Policy & Practice Podcast

image courtesy of iStock

The ink may be dry on the debt ceiling and deficit reduction agreement, but there are still plenty of questions about what it will mean for doctors. The plan to cut trillions in federal spending did not address the Sustainable Growth Rate formula (SGR), the loathed payment formula used to set Medicare physician fees. On Jan. 1, 2012, physician payments are slated to be cut by 30% because of the SGR. Some physicians say that without congressional action to avert the scheduled cut, access to health care could be in jeopardy.

Meanwhile, the debt agreement set up a bipartisan committee that will recommend additional spending cuts. This committee could take aim at Medicare, Medicaid, and the Affordable Care Act.

In other bad news for physicians, a new study in the journal Health Affairs shows that American doctors spend nearly $83,000 per year to deal with health plans and paperwork. That’s four times what their counterparts in Canada spend. For details on this and more, check out the Aug. 8 edition of the Policy & Practice Podcast.

Take a listen and share your thoughts.

The Policy & Practice team will be taking a short summer break, but check back on Aug. 22 for all the latest news on health reform and what it means for you.

Examining the IPAB: The Policy & Practice Podcast

The Independent Payment Advisory Board, the new panel that will be charged with reducing the growth in Medicare spending, was the focus of intense debate on Capitol Hill last week. In the July 18 edition of the Policy & Practice podcast, we have all the details on the two House hearings held on the panel and why physicians are worried about its impact.

The Independent Payment Advisory Board (IPAB) was created under the Affordable Care Act to help keep Medicare spending under control. But most physician groups are calling on Congress to scrap the board or substantially change how it operates. Opponents, who include the American Medical Association, say that if the IPAB goes forward, physicians would be subject to two levels of cuts: one from the IPAB and one from Medicare’s Sustainable Growth Rate (SGR) formula. Physicians are already facing a nearly 30% Medicare fee cut next year from the SGR unless Congress steps in.

HHS Secretary Kathleen Sebelius tours Frager’s Hardware Store in Washington, D.C., before an event to announce new rules on health insurance exchanges. HHS photo by Chris Smith.

This week’s Policy & Practice podcast also has news on the new federal regulations for how states can set up health insurance exchanges. Those exchanges, which aim to make it easier for Americans to buy insurance, are slated to be up and running by 2014. And check out the podcast for the latest on the debt ceiling negotiations and how Medicare could be affected.

Take a listen and share your thoughts:

Check back with us next week for more on the debt ceiling legislation and the Institute of Medicine’s recommendations on what preventive services health plans should cover for women.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

A Chance at an SGR Fix?: The Policy & Practice Podcast

There’s a lot at stake in the negotiations over raising the nation’s debt limit, from the impact on the global economy to the potential elimination of Medicare’s Sustainable Growth Rate (SGR) formula. That’s right, the much-despised SGR, which is used in determining physician payments under Medicare, has even made its way into the talks about increasing the debt ceiling.

House Speaker John Boehner (left) and Senate Majority Leader Harry Reid (right) met with the President on July 10 to discuss the debt limit. Official White House Photo by Samantha Appleton.

As the president and congressional leaders go into overdrive, holding daily meetings on ways to trim the deficit, the medical establishment is pushing hard for lawmakers to stop the cycle of threatened physician pay cuts followed by last-minute legislative Band-Aids. The American Medical Association, along with more than 100 state and medical specialty societies, recently sent a letter to lawmakers warning that the cost of an SGR fix will only go up. Right now, they estimate the 10-year cost of replacing the SGR is nearly $300 billion, but that figure could rise to more than $500 billion in just a few years, they wrote. The debt ceiling legislation provides “the best—and perhaps only—opportunity to ensure stability in Medicare payments, ensure continued beneficiary access to care, and address the SGR deficit in a fiscally responsible manner,” the organizations wrote in their letter.

Get the full scoop on the SGR in this week’s Policy and Practice Podcast.

Take a listen and share your thoughts:

And stayed tuned next week for all the details on new regulations on state-based health insurance exchanges.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

Rolling Out Health Reform: The Policy & Practice Podcast

Many of the hallmarks of the Affordable Care Act, such as state-based health exchanges to purchase insurance, won’t go into effect until 2014. But, in the meantime, officials at the Department of Health and Human Services are plenty busy rolling out other provisions of the law, making adjustments to some of the law’s programs, and just promoting what they’ve done so far.

Recently, HHS officials announced that they would stop granting exemptions that allow limited-benefit health plans to keep in place low annual coverage limits that are at odds with the Affordable Care Act. HHS has been granting waivers to these so-called “mini-med” plans in an effort to keep the products affordable for consumers. But no more. Starting on Sept. 23, HHS will no longer accept waiver applications or extension requests from these plans. And, in 2014, all health plans will be barred from placing annual limits on coverage under the health reform law.

HHS has also been busy promoting the availability of free preventive services for Medicare beneficiaries. Starting at the beginning of this year, Medicare beneficiaries were eligible to receive recommended preventives services ranging from mammograms to smoking cessation counseling with no copays or deductibles under Medicare Part B.

Photo courtesy National Cancer Institute.

But seniors haven’t flocked to take advantage of the services. Only about one in six Medicare beneficiaries has accessed the free services, according to a government report. So HHS is launching a public outreach campaign that includes radio and TV ads. The government is also reaching out to physicians, asking them to discuss the preventive services with patients.

For more on the implementation of the Affordable Care Act, plus a recap of the American Medical Association’s House of Delegates meeting, check out this week’s edition of the Policy & Practice podcast.

Take a listen and share your thoughts:

The Policy & Practice podcast is taking a break next week, but check back on July 11for all the latest developments in health reform.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

A Sales Pitch for ACOs

There’s been a lot of criticism of the accountable care organization (ACO) concept lately, or more precisely, the federal government’s proposal to share Medicare savings with qualifying ACOs starting next year.

That proposed regulation, which was released at the end of March, outlined how qualifying ACOs could earn additional payments if they could save the Medicare program money. But there were plenty of caveats. The Centers for Medicare and Medicaid Services proposed that ACOs meet a certain threshold of savings before they could get any money back. And the rule also set rigorous standards for quality of care, requiring ACOs to meet 65 quality measures.

Since the rule came out, many physicians’ groups have criticized the proposal, saying that it made it too difficult for physicians to get involved. The steep up-front investment in technology, workflow redesign, and staffing, coupled with the uncertainty of achieving savings, would be too much for many practices, they argued. And even officials at the Cleveland Clinic, a health system that many viewed as a prime candidate for being a successful ACO, have said they see major problems with the Medicare plan for ACOs as it stands today.

Dr. Don Berwick. Photo by Laurie Swope.

Earlier this week, Dr. Don Berwick, the CMS administrator, defended the direction his agency is headed with ACOs. In a speech to participants at an ACO learning session sponsored by CMS in Minneapolis, Dr. Berwick said ACOs are one big step toward building a different, better health care system that promises to improve care for individuals and the population as a whole, all while lowing cost. But he admitted that it was a “very, very difficult step.”

There will be growing pains for everyone in the health care industry as they move forward with ACOs, he said. For instance, physicians, nurses, and other health care providers will have to learn to work together in teams to care for patients with chronic illnesses. Physicians working in the operating room and in the intensive care unit will need to truly embrace checklists. And everyone will have to grow used to their electronic health records and disease registries. Prevention, he said, must become an “obsession.”

And beyond those cultural changes, there are many other obstacles. There’s stranded capital, Dr. Berwick said, and a workforce that is underinvested in primary care and not well suited to supporting continuity of care. There are immature metrics to measure what goes on in an ACO and limited capacity to use the metrics that do exist, he said. Plus, there’s the problem that most of the money paid out by Medicare and private insurance is for the volume of care delivered, not the quality of care received.

But those aren’t reasons to shy away from ACOs or other fundamental reforms of the health care system, Dr. Berwick said. To help overcome some of the obstacles to the success of ACOs, CMS’s Innovation Center is holding learning programs like the one in Minneapolis. They are also experimenting with the idea of advancing funds to promising ACOs that lack start-up money. And they are working to get better data out of the Medicare system. “We intend to help,” Dr. Berwick said.

How many ACOs are likely to emerge next year when the program begins? Dr. Berwick said he doesn’t know, but he’s hopeful that officials at CMS can craft a final rule that will attract many organizations. He urged physicians, hospitals, and others to consider taking a leap of faith, despite the risks. “I ask you to think again about what you risk if, while the world shifts around you, you choose to stand still.”

So does Dr. Berwick make a convincing case for ACOs and the government’s shared savings program? Let us know what you think.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

Fixing the SGR: The Policy & Practice Podcast

Doctors know that the Medicare physician payment system is broken. Lawmakers know it. Maybe even some patients know it, too.

The problem is how to fix it so that it doesn’t bust the federal budget. And if lawmakers choose to replace the Sustainable Growth Rate (SGR) formula, which is currently used to determine physician payments under Medicare, they will face another challenge: choosing a new formula that won’t create the same problems in a few years.

Medicare payments could fall off a cliff if Congress doesn't act this year. Image via Wikimedia from User Urban.

The Medicare Payment Advisory Commission, which advises Congress on all things Medicare, has come out with a new report that outlines several alternatives to the SGR. In its report, MedPAC tells lawmakers that by replacing the SGR with a structure that doesn’t have scheduled payment cuts to doctors, they would have the chance to adopt other payment changes that could save the system money.

For example, in exchange for across-the-board pay increases to physicians, Medicare officials could reduce payments for specific services that are overpriced, they wrote. Or they could shift payments away from procedures and toward services that promote care coordination and population health.

Get all the details on the SGR, Medicaid reform options, and the 2012 GOP presidential field in this week’s Policy & Practice podcast.

Take a listen:

And check back throughout the week for all the policy news out of the American Medical Association’s House of Delegates meeting.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

Court Tackles Individual Mandate: The Policy & Practice Podcast

The Affordable Care Act faced its third appeals court challenge, the biggest and most important to date. This case, brought by 26 states,  centers around the constitutionality of the individual mandate, as well as the massive expansion of Medicaid. The judges in the case  didn’t seem persuaded to toss the law or deem its mandate unconstitutional, at least according to experts who observed the oral arguments in Atlanta. However, a final ruling is not expected for several months.

Photo courtesy of iStock

And physicans and hospitals aren’t biting when it comes to the Pioneer model for Accountable Care Organizations (ACOs). The Pioneer program, which has been offered as a sort of olive branch to health care providers unhappy with the proposed ACO rules, presents a fast track  to Medicare shared savings for those who are already functioning under a coordinated care system. Medicare officials extended the deadline for applying to Pioneer by about a month — most likely prompted by the negative feedback on the ACO proposal.

And a plus in this week’s edition: We preview the upcoming annual House of Delegates meeting of the American Medical Association.  Take a listen to the Policy & Practice podcast.

— Frances Correa (on Twitter @FMCReporting)