| ACOFP Advocacy Initiatives Focus on Payment and Medical Liability Reforms |
The American College of Osteopathic Family Physicians continues to focus its lobbying efforts on physician payment. However, issues of medical liability reform, health information technology, and the patient centered medical home are beginning to take shape in both chambers.
Discussions and legislation centered on each issue is likely, as well as emphasis on how each component contributes to improving the broader health care delivery system. All priority issues affecting osteopathic family medicine will be closely monitored.
Medicare SGR Legislation
This issue of reforming the current Sustainable Growth Rate (SGR) payment formula is of paramount importance for ACOFP. The issue is also of key interest to House and Senate Democrats and Republicans.
Although, there have been strong commitments to addressing the broken physician payment system by the 110th Congress, ACOFP remains vigilant in its efforts. First and foremost, the SGR must be repealed and replaced immediately.
The formula must be replaced with a payment formula that adequately and appropriately compensates physicians for the care they provide along with increases to account for rising practice costs. The new formula must provide annual positive updates.
Congress has made it clear that a long-term solution to the current system is vital; however, as a result of “pay-go” rules, it will become quite difficult. Nonetheless, congressional staff is working to review all options available for a long-term, multiple year, and one-year solution.
All options are being explored in order to develop a viable solution that works. Congressional staff is also quite aware of the history of the SGR payment formula. They are often quick to point out that the initial years actually provided physicians with large annual updates and indeed worked in physicians favor.
They further understand the problems associated with the years that follow when payments have gone down hill. They do not want to establish yet another payment system that will lose functionality a few years after inception.
ACOFP Recommendations for Fixing Flawed SGR Formula
ACOFP recently joined the AOA and 85 other physician groups in developing and signing an “Outline for 2007 Medicare SGR Legislation” as a follow up to the “Joint Recommendations to Congress on Eliminating the SGR” from March.
The document lays out specific legislative options aimed at repealing the SGR formula and replacing it with a more equitable system. The document also includes a pathway option, designed to provide Congress a means of transitioning away from the SGR to a new formula.
Recommendation 1: The SGR should be repealed and replaced with an update system that reflects increases in physicians’ and other health professionals’ practice costs.
Provision 101: Enact legislation that permanently repeals the SGR formula and utilizes the same approach for Medicare payment updates for physician and health professional services as is currently used for hospitals, nursing homes and other providers. Updates would be determined through a two-step process involving the Medicare Payment Advisory Commission (MedPAC) making a recommendation to Congress using its payment update framework and Congress reviewing and acting on the MedPAC recommendation. The starting point in the MedPAC process is the forecast increase in medical practice costs.
Recommendation 2: Congress should support initiatives by organizations representing physicians and other health care professionals to bridge gaps in care and assure the appropriateness of services provided to Medicare beneficiaries.
Recommendation 3: If immediate repeal of the SGR is not possible, Congress must: establish by law a transition, pathway and “date certain” to complete elimination of the SGR; provide positive physician/health care professional updates set by statute for each year until repeal takes effect; stabilize payments for a minimum of two years by providing positive baseline updates to all physicians/health care professionals; spend down the costs of repealing the SGR by fully funding the positive updates; and urge the Administration to exercise its authority to remove physician-administered drugs from the SGR and make other refinements in the formula to help reduce the cost of Congressional action.
Recommendation 4: The transitional 2007 Medicare Physicians Quality Reporting Initiative should be re-examined before being expanded into future years.
Capitol Hill Update
SCHIP Reauthorization
The State Children’s Health Insurance Program (SCHIP) will expire on September 30, 2007 and must be reauthorized. There is much debate over what that reauthorization should look like and how it will be funded.
The House Energy and Commerce, House Ways and Means, and Senate Finance committees are working feverishly to bring reauthorization bills to the floor in June, although it remains unclear whether the respective bills will be strictly focused on SCHIP or if they will be a larger health care package to include a physician payment fix.
Passage of the Fiscal Year 2008 Budget by the House and Senate is a great load off of the elected officials. Over the next few months, passage of all appropriations bills will be quite time consuming as well as potentially contentious.
Improving Medicare
Quality and Efficiency
On May 10, 2007, the House Ways and Means Subcommittee on Health held a hearing focused on “Options to Improve Quality and Efficiency Among Medicare Physicians.” This hearing was the first in a series of hearings to examine all parts of the Medicare system.
The hearing was heavily focused upon utilizing both data and incentives to physicians to provide high quality and efficient care. Topics included care coordination, bundled payments, medical home, and profiling of practice patterns.
The issue of inadequate physician payment was best captured by Chairman Pete Stark (D-CA), “It has been far too long since our Committee has taken a thoughtful look at the payment systems for fee-for-service providers. Let’s not forget that the vast majority of Medicare beneficiaries and payments are under the fee-for-service system. As stewards of the Medicare program, we must take seriously our oversight responsibilities to ensure that Medicare pays efficiently and appropriately for quality care.”
Ranking Member Dave Camp (R-MI) echoed the sentiments of Chairman Stark in adding that short-term physician payment fixes are only exacerbating the problems existing in the physician reimbursement system.
The first panel consisted of A. Bruce Steinwald, Director of Health Care at the Government Accountability Office (GAO), Herb Kuhn, Acting Deputy Administrator at the Centers for Medicare and Medicaid Services (CMS), and Glenn Hackbarth, Chairman of the Medicare Payment Advisory Commission (MedPAC).
Steinwald discussed physician practice profiling as a fine line in that every effort must be taken to adjust for differences in patient mix as well as other important factors. Kuhn was of the mindset that bundling of physician payments is a fine model; however, one that becomes difficult to administer with small and very specialized physician groups. He emphasized the necessity of accurately measuring physician resource use while also accounting for the many factors that affect the physician’s decisions.
Hackbarth focused on his belief that care management and coordination would greatly eliminate waste as well as patient confusion. He further stated that physicians must be rewarded and adequately compensated for this type of service through the reimbursement system.
The second panel included Robert Berenson, MD, Senior Fellow at the Urban Institute, Rick Kellerman, MD, President of the American Academy of Family Physicians, Anmol Mahal, MD, President of the California Medical Association, and John Mayer, MD, President of the Society of Thoracic Surgeons. The comments of this panel addressed physician concerns of both profiling as well as care coordination type models.
The consensus of the panel was that profiling must be confidential and only provided to the individual physician in order to compare practice patterns with other similar physicians based upon various factors. On the other hand, the panel was a bit divided as far as bundling of services and care coordination in terms of whether or not a “gate keeper” would emerge.
Questioning by the members of the committee present was primarily focused upon the profiling concept and whether or not CMS was capable of collecting and disseminating that data. Kuhn’s response was that CMS is poised to collect and monitor this data. Although, the trade press focused a great deal of attention on this exchange, it was a very minor focus of the hearing. Mr. Kuhn, in his written statement as well as the physicians present on the panel, made it quite clear that profiling data should be confidential and reported only to the individual physician.
Alternative Approaches to Medical Liability Reform
Sen. Max Baucus (D-MT) and Sen. Mike Enzi (R-WY) recently introduced the “Fair and Reliable Medical Justice Act.” They were joined by Rep. Jim Cooper (D-TN) and Rep. Mac Thornberry (R-TX) who will be introducing a similar House version of the bill.
The legislation is intended to restore fairness and reliability to the medical justice system by encouraging alternatives to current medical tort litigation. Also, the bill is aimed at promoting patient safety through disclosure of health care errors.
The legislation would authorize the Secretary of Health and Human Services to award grants for state demonstration programs. Grants would be utilized for developing, implementing, and evaluating alternatives to current tort litigation in patient injury cases. The Secretary would be authorized to award a total of 10 grants, each not to exceed 5 years and covering a diverse range of “alternatives.”
State requirements for grants:
Grant review panel appointed by Comptroller General:
Preference in awarding of demonstration grants will be given to those states that propose an alternative system that has been developed through consultation with patient advocates, health care providers, and attorneys. These states must also submit proposals that are likely to enhance patient safety through reducing medical errors.
Reporting:
Truth and Transparency
Reps. Jim McDermott (D-WA) and John Sullivan (R-OK) recently introduced the “Healthcare Truth and Transparency Act of 2007” (H.R. 2260). The bill is similar to legislation introduced in the 109th Congress.
The bill would make it unlawful for any health care provider who is not a medical doctor or doctor of osteopathic medicine to make deceptive or misleading statements, or engage in any deceptive or misleading acts, that deceives or misleads the public or a prospective or current patient that such person is a medical doctor or doctor of osteopathic medicine or has the same or equivalent education, skills, or training as a medical doctor or doctor of osteopathic medicine. The bill authorizes the Federal Trade Commission to enforce the provisions of the bill.
The bill also requires that a health care provider who is not a medical doctor or doctor of osteopathic medicine identify, in any advertisement in any medium for health care services provided by such person, the license under which such person is authorized to provide such services.
Updated EHR Regulations
The Internal Revenue Service (IRS) recently released a directive regarding exempt hospitals that subsidize electronic health record programs for medical staff members.
According to the IRS, "we will not treat the benefits a hospital provides to its medical staff physicians as impermissible private benefits in violation of section 501(c)(3) of the [Internal Revenue] Code if the benefits fall within the range of Health IT Items and Services that are permissible under HHS EHR Regulations.”
The Department of Health and Human Services (HHS) published final regulations on August 8, 2006 that permitted hospitals to provide EHR software and technical support to staff physicians at subsidized prices without violating the physician self-referral (Stark) or the anti-kickback statute.
The May 11 directive from the IRS also gives some relief provided that the hospital operates in the following manner:
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.