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March, 2007

  ACOFP Joins Physicians' Group in Calling for Health Care System Reform

A compilation of timely legislative issues for osteopathic family physicians

By Marcelino Oliva, DO, FACOFP and Ray Quintero

The ACOFP joined the American Osteopathic Association (AOA), along with eight other physicians’ groups, in agreeing to 11 “Principles for Reform of the U.S. Health Care System.” The premise of these principles is that health care coverage for all is needed to facilitate access to quality health care, which will in turn improve the individual and collective health of society.

“As osteopathic family physicians, we believe that every American should have appropriate health care, and these principles certainly support that goal,” said ACOFP President Thomas N. Told, DO, FACOFP dist. “It is our duty to make sure only the highest quality of care is being delivered in the health care marketplace, and we hope to work with Congress this year on making these principles a reality.”

The principles are:

  1. Health care coverage for all is needed to ensure quality of care and to improve the health status of Americans.
  2. The health care system in the U.S. must provide appropriate health care to all people within the U.S. borders, without unreasonable financial barriers to care.
  3. Individuals and families must have catastrophic health coverage to provide protection from financial ruin.
  4. Improvement of health care quality and safety must be the goal of all health interventions, so that we can assure optimal outcomes for the resources expended.
  5. In reforming the health care system, we as a society must respect the ethical imperative of providing health care to individuals, responsible stewardship of community resources, and the importance of personal health responsibility.
  6. Access to and financing for appropriate health services must be a shared public/private cooperative effort, and a system which will allow individuals/employers to purchase additional services or insurance.
  7. Cost management by all stakeholders, consistent with achieving quality health care, is critical to attaining a workable, affordable and sustainable health care system.
  8. Less complicated administrative systems are essential to reduce costs, create a more efficient health care system, and maximize funding for health care services.
  9. Sufficient funds must be available for research (basic, clinical, translational and health services), medical education, and comprehensive health information technology infrastructure and implementation.
  10. Funds must be available for public health and other essential medical services to include, but not be limited to, preventive services, trauma care and mental health services.
  11. Comprehensive medical liability reform is essential to ensure access to quality health care.

MedPAC 2008 Recommendation
On January 10, 2007, the Medicare Payment Advisory Commission (MedPAC) voted unanimously to send a recommendation to Congress to increase Medicare payments to physicians by 1.7 percent in 2008. The increase is based upon the Centers for Medicare & Medicaid Services (CMS) “input prices.” According to CMS, the components that affect providing physician care will increase by three percent in 2008. MedPAC estimates physician productivity increasing by 1.3 percent in 2008. The difference between the two factors leaves 1.7 percent as the recommended update.

MedPAC is also finalizing its report to be filed with Congress regarding alternatives to the Sustainable Growth Rate (SGR). The report is expected to highlight several different “pathways” to be considered by Congress and will not make any specific advice as to which “pathway” to pursue. Expected “pathways” include:

Quality Reporting for 2007
Thomas Valuck, along with Terry Kay of CMS, held a briefing on the Tax Relief & Health Care Act provisions on quality reporting for 2007 and 2008. The following information given was based on the statutes in the Act.

Consensus-based quality measures
During the period beginning July 1 and ending Dec. 31, 2007, the quality measures to be used are the 66 measures under the Physician Voluntary Reporting Program. Valuck said any changes must be based on the results of a consensus process in January and published on the CMS Web site by April 1.

Valuck noted that a consensus process is not CMS holding a regulatory meeting about quality measures. A consensus process has to be like AQA or National Quality Forum (NQF). CMS has asked AQA to expand its umbrella to bring in all eligible professionals, including non-physicians. The AQA held its meeting Jan. 22.

Anders Gilberg, of the American Medical Association (AMA,) said the Physician Consortium plans to give its final measures to AQA by the Jan. 22 meeting. Valuck said the AMA’s Physician Consortium has offered its copyrighted measures to non-physicians. The consortium also has agreed to consider evidence of groups not currently covered. Valuck encouraged those who don’t have quality measures to get in touch with the Physician Consortium, AQA and NQF.

Quality measures for 2008 will go through a rulemaking process with a proposed rule no later than Aug. 15 and will address the use of medical registries. The measures have to be endorsed or adopted by a consensus organization such as AQA or NQF. The measures do not have to be fully developed before submitting to the organizations, but the submitter must be able to prove the measure is valid, according to Valuck. Michael Rapp is the coordinator for investigating the registries.

Identification Units
For 2007, CMS will use the taxpayer identification number as the billing unit, but it has not made any decision on what ID to use for analysis – individual or group level. Using the individual level or group level could create a muddle, according to Valuck.

Quality Reporting
If no more than three quality measures are indicated, the physician chooses only the ones that are applicable to his services. If four or more measures are applicable, then the physician reports on at least three measures. In addition, physicians must report the measures on at least 80 percent of the cases to be eligible for the bonus. The physician determines which measures to use. CMS will validate (i.e, through sampling) whether the applicable measures have been reported. In other words, if a physician only reports on one or two measures when three measures were applicable, CMS will deny the bonus payment. The sampling validation will not be open to the review process, but must have some form of due process.

Bonus Payment
Calculating the bonus payment appears to be one of the more confusing provisions on quality reporting. The bonus is 1.5 percent, based on the allowed charges for covered services under the physician fee schedule furnished during the reporting period (July-Dec.). Claims must be submitted no later than two months (by Feb. 28) after the end of the reporting period. Physicians would receive a lump sum payment in 2008. Note: The Health Professional Shortage Area (HPSA) bonus will not be part of the calculation.

Bonus Cap
The Tax Relief & Health Care Act limits the bonus payment. Calculating the bonus cap appears to be one of the more confusing provisions on quality reporting. There are three components to the bonus cap:

  1. Average per measure payment amount;
  2. 300 percent of the average per measure payment amount; and
  3. The number of instances the measures are reported.

The cap will be a product of the total number of quality measures reported by the provider and 300 percent of the average per measure payment amount.

The average per measure payment amount is equal to the total number of allowed charges for all covered services furnished during the reporting period on claims for which quality measures are reported; divided by the total number of quality measures for which data are reported during the reporting period.

Physician Assistance & Quality Initiative Fund
Congress allotted $1.35 billion for the fund. Valuck said the intent for the fund is still under consideration. Valuck speculated that the money may be used to fund the payment update next year if Congress acts to fix it.

The agency anticipates many inquiries about the quality reporting program and expects to release FAQs in the near future. The current PVRP measures are available on the CMS web site at http://www.cms.hhs.gov/PVRP/. Any changes will be published on the site by April 1.

Part D – Negotiations
The House of Representatives approved the “Medicare Prescription Drug Price Negotiation Act of 2007” (H.R. 4) with a 255-for to 170-against vote. The bill was originally introduced by Rep. John Dingell (D-MI), House Energy & Commerce Committee Chairman.

H.R. 4 amends part D of title XVIII of the Social Security Act to require the Secretary of Health and Human Services to negotiate lower covered part D drug prices on behalf of Medicare beneficiaries for plan years beginning January 1, 2008.

The major provisions of the legislation are:

“House Call of the Future”
The “House Call of the Future” is an online program that is being tested in 36 medical offices across the nation over the next two years. The program will establish an “online office visit” that will enable patients to submit information via drop down menus. The on-line physician will then prescribe medication or ask the patient to come in for an office visit. Under either scenario, the patient is charged the same amount as a co-pay for an office visit.

The American Academy of Family Physicians (AAFP) recently began an $8 million project called TransforMED. This program is aimed at addressing high medical costs as well as the lack of new family physicians. Ideally, more students will enter the primary care field by showing them that the use of technology such as “on-line office visits” can be efficient, create more flexible schedules and improve relationships with patients. This patient-centered and physician-friendly model is the foundation of the new virtual office.

100 Hour Agenda Completed

?The 110th Congress got underway on January 8 with an ambitious “100 hour” agenda set forth by the Democrats. In the first nine working days, the House and Senate both debated and approved several important legislative initiatives.

  • H.Res. 6 – Pay-as-you-go: On January 5, the House adopted the “Pay-go” rule, committing to creating no new deficit spending by paying for legislative initiatives as they are passed.
  • H.R. 1 – September 11th Commission Recommendations: On January 9, the House approved legislation that would implement the recommendations of the September 11th commission requiring homeland security grants to be provided primarily on the basis of risk, while still ensuring minimum amounts for each state.
  • H.R. 2 – Minimum Wage Increase: On January 10, the House voted to increase the federal minimum wage by $2.10 over two years, from the current level of $5.15 an hour to $7.25 an hour.
  • H.R. 4 – Medicare Prescription Drug Prices: On January 12, the House approved legislation giving the Secretary of Health and Human Services broad authority in deciding how to negotiate prices on behalf of Medicare’s private drug coverage plans.
  • H.Res.35 – Appropriations Intelligence Oversight Panel: On January 9, the House voted to amend the rules to create a new Select Intelligence Oversight Panel within the House Appropriations Committee.
  • S. 197 – Judges’ Cost of Living Adjustment: On January 8, the Senate approved legislation that would provide a 1.7 percent increase in pay for federal judges, beginning January 1.
  • H.R. 475 – House Page Board Overhaul: On January 19, the House approved measures that will change to composition of the oversight panel of the House Page program to provide an equal number of majority and minority members, as well as members representing parents of pages and former pages. This increases the size of the board to eight members.
  • S.1 – Ethics and Lobbying Overhaul: On January 18, the Senate amended and approved lobbying and ethics rule changes with regard to Senators and their staffs. This legislation also restricts the use of and expands the definition of earmarks.
  • H.R. 6 – Energy Policy: On January 18, the House approved policy that would shift certain revenue from royalties and tax incentives from oil and gas companies to a reserve fund for alternative and renewable energies.
  • H.R. 5 – Student Loan Rates: On January 17, the House approved legislation that would reduce student loan interest rates by half over the next five years for undergraduates with subsidized loans.
  • H.R. 434 – Small Business Administration Extension: On January 17, the House authorized, until December 31, all programs, authority and provisions – including pilot programs – implemented before September 30, 2006, by the Small Business Administration.
  • H.R. 391 – Home Equity Conversion Mortgage Volume Cap Removal: On January 16, the House voted to remove the 275,000 limit set by the FY 2007 Continuing Resolution on the number of home equity conversion mortgages the Federal Housing Administration can insure.

 

Marcelino Oliva, DO, FACOFP chairs the ACOFP Committee on Federal Legislation. Ray Quintero serves as ACOFP’s Director of Government Affairs. ACOFP members may contact Mr. Quintero at 800-962-9008, extension 8648, or by e-mail at rquintero@osteopathic.org.