Tag Archives: House

House: System Reforms Second to SGR Repeal

Delivery system reforms come second to repealing the Sustainable Growth Rate formula. That’s according to congressional testimony by private sector payers at a recent hearing of the House Ways and Means Committee.  While each of the panelists presented compelling ideas for delivery system reform, all agreed that the first step to progress is a new payment model.

“The extent to which Medicare can more more swiftly to payment reforms, I think we’d see progress there,” said panelist Dr. Jack Lewin, the chief executive officer of the American College of Cardiology.

Rep. Mike Thompson (D-Calif.) said SGR repeal, not delivery reform, is the number one concern of both doctors and Medicare beneficiaries.

Alicia Ault/Elsevier Global Medical News

“[Doctors] want to make sure that they’re going to get paid for the medical services they provide and Medicare patients want to make sure they’re going to have a doctor to go to; and it stops right about there,” he said. His concerns were echoed by Ranking Member Pete Stark (D-Calif.).

“We keep avoiding the topic of Sustainable Growth Rate formula, in favor of the easier conversations about delivery system reforms, around which we have much stronger agreement,” Rep. Stark said.

Dr. John Bender, president and CEO of Miramont Family Medicine of Fort Collins, Colo., testified that if SGR is not repealed, doctors could have a harder time keeping their practices afloat. He added that he was forced to take out $70,000 loan to cover payroll 4 years ago when SGR was not repealed and Medicare payments were delayed. Today, with stricter policies on loans, that might not be an option, Dr. Bender said, and his practice could go bankrupt.

Len Nichols, director for health policy research and ethics at George Mason University, testified that the Affordable Care Act has brought an end to “business as usual.” He said that Medicare and private payers must work together to find savings, or else face steep cuts.

“We could cut our way to fiscal balance, and in so doing, reduce access to care for millions of Americans. I fear this pathway would likely fail,” Nichols said. “Alternatively, we could align incentives so thoroughly that we actually link the self-interest of clinicians with our common interest in cost reduction and quality improvement, which covering all Americans.”

Rep. Thompson called on his fellow lawmakers to put partisan differences aside to solve the problem that Congress created.

“We have dropped the ball on this one … We need to come together as members of Congress, party stripe not withstanding, and figure out how we come up with the dollars to fix this,” he said.

—Frances Correa (@FMCReporting on Twitter)

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The Trauma of Politics in Medicine

It’s been a quick reversal for the Susan G. Komen for the Cure Foundation, reinstating funding some 72 hours after cutting off Planned Parenthood because of new criteria barring grants to organizations under investigation, prompted in this case, by a Republican congressman.

“We will amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political,” Komen CEO and founder Nancy Brinker said in a statement issued Friday.

The uproar brought more than $3 million in donations to Planned Parenthood in just three days, but also highlights the volatile mixture of politics and medicine.

Dr. Richard Carmona recently observed that one of the most popular presentations he made during his tenure as the 17th Surgeon General of the United States did not address emerging infections, physical trauma, or national diasters, but rather the plague of politics in medicine.

“This traumatic plague of politics is more insidious and virulent than emerging infections; has potentially more morbidity and mortality than hemorrhagic shock or blunt or penetrating trauma; has virtually no diagnostic criteria; and is resistant to all therapy, especially voices of reason, substantive discussion or positions of compromise,” he said during a memorial lecture at the recent meeting of the Eastern Association for the Surgery of Trauma.

Dr. Richard Carmona Patrice Wendling/Elsevier Global Medical News

Dr. Carmona didn’t have far to look for examples to flesh out his diagnosis.

More than a century ago, public health officials’ efforts to control the bubonic plague outbreak of 1900 in San Francisco were nearly derailed by politicians who claimed that quarantine procedures, including closing the city’s harbor to incoming ships, were an over-reaction that would impede commerce and tourism, and result in the collapse of San Francisco, and possibly California. The Surgeon General who intervened based on the scientific evidence was labeled a heretic and asked to resign.

In the 1980s, similar calls were made after former Surgeon General Dr. C. Everett Koop refused to back down from statements that HIV could be prevented. At the time, Dr. Carmona reminded the audience, senior elected officials were telling the American public that HIV was God’s way of punishing homosexuals.

In the 1990s, the tenure of Surgeon General Dr. Joycelyn Elders  was cut short after controversy erupted over a 1994 speech at the United Nations World AIDS Day that included remarks that masturbation was a normal part of sexuality and that abstinence-only education was “child abuse.”

During his own term under President George W. Bush, Dr. Carmona said, abstinence-only became the mantra of the administration, “based solely on ideological and theological concepts, and not science.

“Science had really demonstrated that abstinence alone was a failed proposition,” Dr. Carmona said. “Ironic, that an administration that was repeatedly caught up in the issue of abortion did not see the connection that comprehensive sex education was the best method to prevent STDs, unwanted pregnancies, and therefore abortions. As Surgeon General, this is a science-based position I have always held.”

Dr. Carmona, the only Surgeon General to be unanimously confirmed to the position in over 200 years, said the trauma of politics and its preventable deleterious outcomes are owned equally by politicians on both sides of the aisle.

He pointed out that over-the-counter sales of Plan B stalled under the Bush administration before gaining limited approval in December 2006, but fared no better seven years later under the more liberal Obama administration. In December 2011, HSS Secretary and Democrat Kathleen Sebelius overruled the FDA’s decision to make the emergency contraceptive available, without prescription, to girls of all childbearing ages. While Sebelius cited a lack of conclusive data, Dr. Carmona said it was the administration’s desire to avoid a political battle in the face of an upcoming election.

“The immunization for preventing the continued viralness of political trauma is transparency, full disclosure, accountability for elected officials, a citizenry that is informed and participatory, coupled with civil discourse of complex issues,” he said.

–Patrice Wendling

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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)

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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)

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Looking Back at Health Reform’s Passage

It was a very bumpy road for the Obama administration to get the Affordable Care Act passed. And if it hadn’t been for a few key developments, it may never have happened at all, according to Dr. Bob Kocher, an internist who currently works for the Center for U.S. Health System Reform at McKinsey & Company. He was previously a member of President Obama’s National Economic Council and was involved in the effort to formulate and pass health care reform.

At the Society of Hospital Medicine’s annual meeting in Grapevine, Tex., this week, Dr. Kocher told thousands of hospitalists just how tough it was to get the Affordable Care Act passed, even with Democrats in control of both the House and the Senate. Health care advisors in the White House started out by trying not to repeat the mistakes of the past, he said. “The System,” the book recounting just how Hillary Clinton’s health care plan had derailed, was required reading. But despite their best intentions, they made many mistakes anyway, Dr. Kocher said.

Official White House photo by Chuck Kennedy.


The rest of the story is well known. The original health care reform bill passed through the House in November 2009. The Senate passed their version of the bill on Christmas Eve. A small group of Democratic lawmakers immediately set to work negotiating a new piece of legislation that would combine elements of the two plans and that would again have to be passed by both chambers. But with the election of Massachusetts Republican Scott Brown to the Senate in January 2010, the administration’s hopes of getting another bill passed through the Senate were dashed. The House Speaker agreed to try to pass the Senate’s original bill through the House instead. But even that wouldn’t have been enough to save health reform if not for a couple of events that happened outside of Congress, Dr. Kocher said.

First, Anthem Blue Cross of California proposed a massive 40% rate hike in the individual insurance market in the weeks before the pivotal second House vote. The proposal garnered headlines, and the Obama administration jumped on the chance to highlight it as a reason to reform the health insurance system. And then Sister Carol Keehan of the Catholic Health Association came out in support of the bill, saying it did not allow for federal funding of abortions, and concerns about the issue could be allayed by an executive order from the President. This gave some anti-abortion Democrats a bit of breathing room to support the bill.

Looking back, Dr. Kocher said administration officials might not have made health reform a top domestic priority if they had known it would take so long to pass and cost them so much politically. He said he’s glad he didn’t know.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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SGR Alternatives: Doctors Weigh In

The House Committee on Energy and Commerce will hear alternatives to the highly contentious Medicare Sustainable Growth Rate (SGR) formula at a Thursday hearing. The hearing follows up on a March 28 letter to 51 medical organizations in which the committee requested feedback on how to remedy the Medicare  payment system, which the committee wrote “… is a major threat to the integrity of the [Medicare] program and the ability of America’s seniors to access quality health care.”

Image via iStock.

In the letter, the committee said it is determined to replace the SGR this year, calling for a system that reduces spending and pays providers fairly and through a value-based system. Under the SGR, Medicare physician payments are scheduled to cut by 29.5% next year; experts estimate it will cost $300 billion to abandon the formula.

Several medical groups responded to the committee’s request, including the American Medical Association (AMA), the American Osteopathic Association (AOA), the American Academy of Family Physicians (AAFP), the American College of Surgeons (ACS), and the American College of Physicians (ACP).

Although the groups’ approaches to an SGR fix vary, their plans share some similarities:  a full repeal of the SGR and creation of a new payment model that break away from a “once size fits all” model. They also suggest a 4-5 year transition period in which physicians can participate in the new payment plan on a voluntary basis.

Additionally, they call for a transition to value-based payment systems and increased emphasis on patient-centered medical homes. The ACS, the AAFP, and the ACP all specifically include the need for higher reimbursements for primary care in their plans.

The committee hearing will be held at 10 a.m. on Thursday. Check here to see if it’s being webcast (they often are).

What do you think Congress should include in any plan to replace the SGR? Tell us in the comments section.

—Frances Correa (@FMCReporting on Twitter)

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GOP Budget Passes the House: The Policy & Practice Podcast

The House passed the controversial GOP budget plan Friday. The plan,  proposed by Rep. Paul Ryan (R-Wis.), delegates Medicaid to the states in the form of block grants. It also would basically privatize Medicare for everyone who is younger than 55 today.  President Obama said the plan will end Medicare as we know it.  He brought forward his own deficit-reduction plan, which he said would get the country back on track within 12 years.

Gov. Haley Barbour said Republican governors will present their recommendation on health care reform to Congress in May. Photo by Alicia Ault

Meanwhile, Republican governors are working up their own recommendations on health reform, which, according to Mississippi Governor Haley Barbour, would include a repeal of the Affordable Care Act.

Listen to this week’s Policy & Practice podcast to hear more. Stay tuned for more updates on May 2, after Congress returns from its two-week break.

–Frances Correa

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Debating the 2012 Budget: The Policy & Practice Podcast

In the next couple of days Congress will finally vote on a budget to fund the federal government for the rest of this year. But the work is only just beginning. Before the President’s signature is dry on that legislation, Congress will begin hashing out the budget for 2012. House Budget Commitee Chairman Paul Ryan (R- Wisc.) recently unveiled the GOP plan for 2012, which calls for a repeal of the Affordable Care Act, along with a total overhaul of the Medicare and Medicaid programs.

Photo by Alicia Ault.

Under the plan, the federal government would convert its share of Medicaid funding into block grants for the states. As for Medicare, the program would stay the same for current retirees and those nearing retirement age. However, for everyone who is age 54 and younger today, the plan calls for privatizing the program. Republicans are touting the plan as responsible budgeting, but many Democrats say it will destroy social safety net programs.

Hear more about the brewing budget fight, physician pay, and malpractice reform legislation in this week’s Policy & Practice Podcast. Take a listen:

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Is Defensive Medicine a Myth?

The issue of medical liability reform has been getting a lot of attention so far this year. A bill proposing caps on non-economic damages was one of the first pieces of legislation introduced in the new Congress. President Obama even mentioned tort reform in his State of the Union speech as a way to bring down health care costs. But now, a consumer advocacy group opposed to capping malpractice damages is saying that tort reform won’t help reduce health spending because estimates of the cost of defensive medicine are inflated.

Image via Flickr user clevercupcakes by Creative Commons License.

In a new report called “Defensive Medicine: The Doctored Crisis,” researchers with Public Citizen make the case that physicians order unnecessary diagnostic tests not because they fear lawsuits, but because there are financial incentives to conduct more testing. They cited a 2008 study from the Government Accountability Office that showed that imaging tests generate a growing amount of revenue for certain physicians. For example, the report found that in 2006 cardiologists obtained 36% of their total Medicare revenue from in-office imaging, up from 23% in 2000.

Public Citizen also criticized claims that defensive medicine comes at a significant cost for the health care system. For example, one of the higher estimates sometimes cited by supporters of tort reform is that defensive medicine accounts for as much as 26% of health care spending. Public Citizen says the real number is likely less than 2%. The problem is that many of the higher estimates are based on unscientific physician surveys that suffer from response bias and a failure to distinguish between useful and wasteful practices, according to the Public Citizen report.

So is Public Citizen right? Is defensive medicine overblown? And if defensive medicine isn’t responsible for driving up the cost of health care, should Congress still be working to address medical liability reform this year? Share your thoughts.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Finding Fraud: The Policy & Practice Podcast

There’s not a lot that Democrats and Republicans agree on when it comes to the federal budget, except maybe fraud prevention. With so much focus on deficit reduction, the two parties have both embraced the idea of aggressively going after waste, fraud, and abuse of federal funds. And they see the Medicare and Medicaid programs as places that are ripe for a crackdown.

Last week, lawmakers held hearings where they tried to get a handle on the scope of the problem. This week, the Senate’s Homeland Security and Governmental Affairs Committee will look at new tools for curbing waste and fraud in the programs.

Image via Flickr user borman818 by Creative Commons License.

Tackling fraud could help the bottom line for physicians, as well as for the federal government. President Obama has said he would like to use money saved through fraud prevention to help pay for a two-year fix to Medicare’s Sustainable Growth Rate, the statutory formula used to calculate payment to physicians.

Hear about this, plus how the Affordable Care Act is being received in the courts and by governors in this week’s Policy & Practice Podcast. Take a listen and share your thoughts:

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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