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.
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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.
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.
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And stayed tuned next week for all the details on new regulations on state-based health insurance exchanges.
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.
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The Policy & Practice podcast is taking a break next week, but check back on July 11for all the latest developments in health reform.
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.
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And check back throughout the week for all the policy news out of the American Medical Association’s House of Delegates meeting.
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.
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:
It’s been a full year since the Affordable Care Act became law, but in many ways it feels like the debate never stopped. Last week, the Obama administration marked the one-year anniversary of the law’s signing by traveling the country to talk up the benefits of health reform. This week Congress is back from its recess and health reform is once again on the agenda for many committees.
Image via Flickr user Tobyotter by Creative Commons License.
The House Energy and Commerce Committee will look at the impact of the law on jobs and the federal budget. Later in the week, members of the House Appropriations Committee will question Health and Human Services Secretary Kathleen Sebelius on the implementation of the health law.
Check out this week’s edition of the Policy and Practice Podcast to hear what the public thinks about health reform and how the American Medical Association is weighing in on regulations coming out of the law.
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And stay tuned next week to see if lawmakers can reach agreement on a federal budget for the rest of this year and what impact it could have on health reform implementation.