Got something to say? Join us in our facebook group and take part in the discussion.

SENATE TO VOTE ON STOPPING MEDICARE PHYSICIAN REIMBURSEMENT!

6/7/2010

On June 1st a 21% across the board cut in Medicare physician pay officially
went into effect.

This is the third time this year the cut has gone into effect before it could be
reversed, and physician organizations are growing increasingly
frustrated by what is frankly a lack of urgency on the part of lawmakers
to fix the situation in a more permanent fashion.

As it did the two previous times, the Centers for Medicare & Medicaid Services
said it would instruct Medicare contractors to hold June claims for 10 business
days, giving the Senate more time to pass the House bill before the program
starts sending doctors' payments at the reduced rate. The extension runs out
after June 14.

The extenders bill that the House approved on May 28 includes a 19-month patch,
under which doctors would receive a 2.2% raise for the rest of 2010,
retroactive to June 1, followed by another 1% raise in 2011. But in 2012,
physicians are scheduled to receive a 33% cut as the system reverts to the old
pay formula baseline.

The Medicare pay portion of the bill was carved out and voted on separately by
House lawmakers, passing by a vote of 245-171. The Senate plans to vote on the
full package of extenders, which also would continue unemployment and health
assistance programs that are expiring, and address other priorities.

The new 19-month patch would boost pay to physicians by an estimated $23 billion
over 10 years. This is down from the $88.5 billion that the five-year freeze
equivalent would have cost, and the $63 billion that the 3½ year plan would
have cost.

Source: www.ama-assn.org

CALL YOUR U.S. SENATE OFFICE THIS WEEK TO VOICE YOUR SUPPORT!!

JOIN US FOR AAPI LEGISLATIVE DAY JUNE 24th !!!!

HOUSE PASSES HEALTH REFORM LEGISLATION

3/23/2010

The U.S. House of Representatives on March 21 cleared a package of comprehensive health system reforms that congressional Democrats have been pushing for more than a year, enabling President Obama to sign into law what is considered to be the most substantial overhaul of the system since the enactment of Medicare in 1965.

By a vote of 219-212 during the lengthy Sunday session, the House approved the Patient Protection and Affordable Care Act, the same reform bill that the Senate passed Dec. 24, 2009. By a subsequent vote of 220-211 the House also approved the Reconciliation Act of 2010, a set of consensus revisions to the underlying reform bill. Thirty-four Democrats and all 178 Republicans in the House voted against the health reform measure, projected to cost roughly $940 billion over 10 years. 32 million uninsured Americans are expected to receive coverage under the reforms. The measure would extend coverage to an estimated 95% of the legal U.S. population through a combination of individual and business mandates, public health expansions, and health insurance reforms. Most Americans will now be required to have health insurance or pay a fine. Larger employers will be required to provide coverage or risk financial penalties. Total individual out-of-pocket expenses will be capped, and insurers will be barred from denying coverage based on gender or pre-existing conditions. The compromise package would add to the bill's total cost partly by expanding insurance subsidies for middle- and lower-income families. The measure would scale back the bill's taxes on expensive insurance plans.

A separate compromise package of changes expanding the reach of the measure also passed the House over unanimous GOP opposition, and is now set to be taken up by the Senate.


KEY POINTS OF THE BILL:

1. According to CBO projections, will cut budget deficits by over $1 trillion in its second decade.
2. It will subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.
3. Creates a series of health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage.
4. Medicaid will be significantly expanded, ensuring coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.
5. Cuts projected Medicare spending by roughly $500 billion, in part through reductions in the Medicare Advantage program. Democratic leaders have promised the reductions will not affect service to Medicare recipients.
6. The bill hikes Medicare payroll takes on families making more than $250,000. Starting in 2013, it also imposes a 40 percent tax on insurance companies providing expensive "Cadillac" health plans valued at more than $8,500 for individuals and $23,000 for families.
7. Individuals are required to purchase health insurance coverage or face a fine of up to $750 or 2 percent of their income -- whichever is greater. It includes a hardship exemption for poorer Americans.
8. Companies with more than 50 employees that don't provide coverage are required to pay a fee of $750 per worker if any of its employees rely on government subsidies to purchase coverage.
The compromise package would drop the individual fine to $695 or 2.5 percent of income, whichever is greater. The fine on companies failing to provide coverage would jump to $2,000 per employee.
9. Federally funded abortion coverage for people purchasing insurance through the exchanges will be banned under the bill now passed by Congress. Exceptions will be made in cases of rape, incest, or danger to the life of the mother.
10. Individuals receiving federal assistance who want abortion coverage will have to purchase the coverage using private funds.
11. Illegal immigrants will be barred from buying insurance in the health insurance exchanges.
12. Parents, however, will be entitled to keep their children on their health care plans until age 26.
13. A deeply unpopular special exemption for Nebraska from all new Medicaid expenses -- known as the "Cornhusker Kickback" -- would be eliminated under the compromise plan. The federal government will instead assist every state by picking up 100 percent of the costs of expanded Medicaid coverage between 2014 and 2016, and 90 percent starting in 2020.
14. Closes the Medicare prescription drug "doughnut hole" by 2020. Under current law, Medicare stops covering drug costs after a plan and beneficiary have spent more than $2,830 on prescription drugs. It starts paying again after an individual's out-of-pocket expenses exceed $4,550. Senior citizens stuck in the doughnut hole this year would receive a $250 rebate.

The bill now goes to the president's desk to sign, after which it will become law.

Senate Votes to Again Delay Medicare Cut
March 10, 2010

The Senate has voted 62-36 to approve a $138 billion bill that would, among other things, stave off planned cuts to Medicare reimbursements until Oct 1.

The House must now approve the measure, which would postpone the scheduled 21% cut mandated under the sustainable growth rate (SGR) formula -- the Medicare accounting scheme that links Part B reimbursement rates to the gross domestic product (GDP).

The SGR was developed as a method to ensure that medical spending doesn't outpace growth in the economy, but because the GDP has grown more slowly than the growth in healthcare spending, the formula has called for large cuts nearly every year since it was enacted in 1997.

In most years, physicians have successfully lobbied for and Congress has nixed the cuts before the end of year. This year, the scrambling went on even longer. The 21% cut was scheduled to go into effect on Jan. 1, but Congress voted to postpone it until March 1. That deadline came and went, leaving CMS to take up the slack when it urged contractors to hold claims until March 12, giving Congress more time to act -- which it did a few days later with a short one month solution.

If the House doesn't pass the bill approved by the Senate on Wednesday (March 10th), the SGR reprieve will expire on April 1.

Doctors groups have grown increasingly tired of the steady stream of short-term fixes and are lobbying hard for a permanent repeal of the SGR.

In addition to the doctor payment cut delay, the bill would also extend COBRA subsidy assistance for the unemployed; extend federal assistance for Medicaid programs for an additional six months; delay an $1,860 reimbursement cap on rehabilitative care; exempt some pharmacies that sell durable medical equipment from an accreditation requirement; extend bonus payments doctors in underserved areas; and make changes to Medicare Advantage programs to test a program meant to evaluate efforts by physicians and hospitals to make care more efficient.

Sources: www.medpagetoday.com; www.acponline.com; www.ama-assn.org

Graduate Medical Education (GME)
January 8, 2010

We received the following message from the AAMC, asking us all to support the expansion of Financial support for GME spots by Medicare funding. I strongly request that you paste the following link into your browser and follow the easy instructions to send a message to our legislators. It will take you < 1 min to send, and will make a big difference to IMG applicants searching for residency positions.

http://capwiz.com/aamc/home/

-----------------------------------------------------------------------------------------------------

Colleagues,

The AAMC has, with your help, been working with Congress on a multitude of issues related to health care reform legislation. One issue of importance to the academic medicine community (and the nation) is an adequate physician workforce to meet the needs of an aging and growing population. The cap on Medicare's support for residency training has been a major barrier to ensuring that our institutions can respond to community needs.

While both the House and Senate language preserve current GME funding, both versions rely on redistribution of unused slots to add only a few hundred physicians a year to the current pipeline. While the cost remains a significant challenge, we continue to press for a 15% expansion of Medicare funded GME positions to be included in the final health care reform bill. Our strategy includes raising the visibility of the issue in opinion-leading media, such as our op-ed in that appears in print and online in yesterday's Wall Street Journal (included below), as well as print advertisements in Capitol Hill publications.

This effort will not succeed, though, unless we can generate enough 'volume' behind the message to distinguish it from the noise of the current negotiations. To that end, I ask that you send a letter to your Members of Congress supporting the expansion of GME using our legislative action center--and ask as many of your colleagues as possible to do the same. http://capwiz.com/aamc/home/

Thank you again for all of your continued help as we enter what look to be the final weeks of the first stage of health care reform!

Darrell

Darrell G. Kirch, M.D.
President and CEO
Association of American Medical Colleges

OPINION JANUARY 4, 2010, 10:45 P.M. ET
http://online.wsj.com/article/SB10001424052748703483604574630321885059520.html

How to Fix The Doctor Shortage
Congress needs to ensure we're cared for by more than an insurance card and an answering machine.
By DARRELL G. KIRCH

Congress is poised to pass a health-care overhaul that would expand insurance coverage to 31 million Americans, but will the newly insured have a physician to care for them?

Our nation currently faces a shortage of physicians expected to worsen as the number of people over age 65 (who use more than twice the health care of younger adults) doubles. Even with significant changes to the health-care delivery system and improved prevention, the United States will face a shortage of more than 125,000 physicians in the next 15 years—a daunting problem considering that we only train about 27,000 new doctors a year. In addition, the U.S. Department of Health and Human Services (HHS) estimates that at least 16,000 more primary care physicians are needed today.

The shortage of primary care physicians and other health professionals is further complicated by an overall physician shortage in most areas of the country. In 2001, new patients were forced to wait an average of eight days to see a family or general practitioner. Overall wait times for all physicians reached almost 15 days that year. Without significant increases in the number of doctors, these delays will only get worse.

On average, it takes three to seven years to fully train a new physician through a process known as residency training (the graduate medical education that all physicians must undergo after eight years of college and medical school). While U.S. medical schools are working to increase their classes by 30%, these new medical school graduates will not increase the nation's overall supply of physicians, or even have a residency position in which to train, unless the government lifts the cap on residency training slots it pays for that was imposed as part of the Balanced Budget Act in 1997.

The doctor shortage affects primary care as well as many medical specialties, even without an expansion of health insurance. According to HHS, overall demand for physician services will increase an estimated 22% between 2005 and 2020, while the number of primary care physicians will increase by only 18% during this period. Worse, the supply of some doctors (such as urologists and general surgeons) is expected to shrink over this period despite the government's assessment that the need for almost all types of physicians will continue to grow. Researchers have suggested that only one specialty, general pediatrics, will have a supply of physicians greater than the demand for their care. But even this surplus seems highly improbable to those of us with children who already have difficulty obtaining timely appointments.

The U.S. health work force has been rightly criticized because the percentage of physicians in primary care is lower than in most of the developed nations to which we often compare our health system. This is a problem many see as directly related to poor reimbursement for primary care services. Yet the number of formally trained family physicians (doctors who care for patients of all ages) doubled between 1985 and 2004, and we still remain without enough doctors in primary care and many other medical fields.

The physician shortage is, in part, a result of expectations in the 1990s that managed care and primary care would greatly drive down the need for physicians, particularly specialists. However, these expectations fell short against the rising needs of an aging, growing population that has high expectations of its health-care system.

Today, the overall number of physicians in the U.S. is lower than the average per capita number of doctors in other nations such as Sweden, Denmark, Spain and France, and we now "import" some 25% of our physicians from other countries. While expansions of U.S. medical schools can close this part of the gap, the overall per capita supply of doctors in the country will decline without an expansion in the number of residency training positions. This expansion will not occur unless Medicare resumes paying for its share of training costs.

Because it takes so long to train a new physician, Congress must lift the freeze on support for medical training now, as part of health-care reform. While the cost to add new physicians is significant, it is less than 1% of current Medicare expenditures and an essential investment if people are to have timely access to a physician's care, not just the promise of insurance coverage. Even those who expect the U.S. health-care system to be transformed in the next decade know that wishful thinking cannot provide the care they and their families will need.

Congress is right to expand insurance to as many Americans as possible. But it also has a responsibility to ensure that the nation is cared for by more than an insurance card and an answering machine.

Dr. Kirch is president and CEO of the Association of American Medical Colleges.

Health Care Reform: Senate vs. House
December 24th 2009

The Senate approved The Protection and Affordable Care Act, a comprehensive health system reform legislation by a strict party-line vote of 60-39 during a rare Christmas Eve session. The legislation now goes to a conference committee, where lawmakers will try to negotiate a consensus bill between the Senate measure and a much different House version that passed by a vote of 220-215 on Nov. 7.

Beginning in 2014, the Senate bill would establish insurance exchanges where consumers could shop for private coverage sold under federal guidelines. Most Americans would be required to purchase insurance or face penalties, and hundreds of billions of dollars in federal subsidies would be available to families up to incomes of about $88,000 a year. Insurance companies would be banned from denying benefits or charging higher fees on the basis of pre-existing medical conditions. That provision would take effect in 2013 in the House version.

The Congressional Budget Office estimates the Senate measure would extend coverage to about 31 million Americans who lack it, while cutting federal deficits by $130 billion over a decade and possibly much more in the following 10 years. To finance extended coverage, the House bill relies on an income tax surcharge on incomes over $500,000 for individuals and $1 million for couples, a provision the Senate omitted. Its bill includes higher Medicare payroll taxes on high wage-earners and a new tax on high-cost insurance policies that labor unions generally oppose. Medicaid, the federal-state health care program for the poor, is expanded in both bills, but the House provision includes many more people. The House legislation also requires large employers to provide insurance to their workers or pay a fine. There is no such mandate in the Senate bill, although companies would face penalties if any of their uninsured employees qualified for federal subsidies to purchase their own insurance.

The House-passed bill is estimated to extend coverage to more individuals than the Senate measure, 36 million over a decade as opposed to 31 million. It also provides more generous subsidies, on average, according to calculations by the Congressional Budget Office. The agency says the approximate average subsidy in 2019 under the House will would be $6,800 a year; for the Senate bill, it is $5,600. Those differences reflect one of the biggest contrasts between the two bills — the $574 billion the House bill provides for subsidies over a decade, as opposed to $336 billion under the Senate measure.

Both bills also rely on hundreds of billions of dollars in cuts in future payments to doctors, hospitals and others who care for Medicare patients, with the largest reduction falling on insurance companies who provide a private alternative to traditional Medicare.

Over 10 years, the House bill closes a gap in coverage under Medicare prescription drug benefits popularly known as the doughnut hole. The Senate bill reduces but does not eliminate that interruption in coverage, Important issues that need to be resolved in the House-Senate conference committee include the scope, authority, accountability and transparency of a payment advisory board. The details of several cost control and quality improvement initiatives also need to be refined so that they do not have unintended consequences for patients and physicians.

Source: Associated Press & AMA News.

House passes H.R. 3961 legislation to permanently repeal the SGR

By a vote of 243-183 today (Nov.19th,2009), the U.S. House of Representatives passed H.R. 3961, a bill that repeals the current Medicare physician payment formula, known as the sustainable growth rate (SGR), and replaces it with a new framework. Michael Burgess, MD, (R-Texas), a former AMA alternate delegate was the sole Republican to vote for final passage.

This legislation would replace the SGR with a new formula that creates two updates: GDP +2 for Evaluation and Management services and GDP + 1 for other services. Additional technical changes will avoid the accumulation or compounding of debt that occurred with the SGR formula.

House Speaker Nancy Pelosi (D-Calif.), House Majority Leader Steny Hoyer (D-Md.), House Committee on Ways and Means Chairman Charles Rangel (D-N.Y.), House Ways and Means Health Subcommittee Chairman Pete Stark (D-Calif.), House Committee on Energy and Commerce Chairman Henry Waxman (D-Calif.), Rep. Frank Pallone (D-N.J.), the bill's sponsor Rep. John Dingell (D-Mich.), and the Obama Administration were strong advocates for passage of H.R. 3961.

House Republican leadership offered a last-minute alternative that would have provided for 2 percent updates over the next four years, reverting back to the SGR and steep cuts. Also, it would have offset the cost with medical liability reforms modeled after California and Texas laws. The AMA opposed the motion to recommit because we do not support any temporary "patches" for the SGR. A permanent repeal is long overdue. The motion to recommit with medical liability reform provisions was ruled non-germane. A second GOP alternative providing for a two-year "patch" was defeated by a vote of 177-253.

The battle now shifts back to the Senate. While action to permanently repeal the SGR was blocked in the Senate last month, the Obama Administration and several senators support a permanent replacement of the SGR formula. The health system reform bill released by Senate Majority Leader Harry Reid (D-Nev.) provides for a one-year reprieve with a steeper cut in 2011.

H.R. 3961, The Medicare Physician Payment Reform Act of 2009
Medicare Physician Payment Reform Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act to revise the Medicare sustainable growth rate (SGR) payment system for determining the annual updates to the Medicare physician fee schedule.
Sets as a transitional update for 2010 to the single conversion factor in the formula for determining the schedule the percentage increase in the Medicare economic index (MEI, a price index of inputs required to produce physician services).
Rebases the update adjustment factor for 2011 and subsequent years by: (1) making the allowed expenditures for 2009 under the schedule equal to the actual expenditures for physicians' services during 2009; and (2) changing from 1996 to 2009 (or, if later, the fifth year before the year involved) the reference point for calculating the cumulative adjustment component to expenditure targets in the formula.<br>
Limits to physicians' services under the fee schedule (excluding those incidental to a physician visit) the services covered in the target growth rate computation.
Establishes two categories of physician services: (1) evaluation, management, and preventive services; and (2) all other physician services. Prescribes a separate target growth rate and conversion factor update for each such category.

See Link to HR 3961 Legislation: http://www.gop.gov/bill/111/1/hr3961

Health System Reform Bulletin Special Alert - Oct. 16 2009

http://www.ama-assn.org/ama/pub/health-system-reform/bulletin/16oct2009.shtml

Call (800) 833-6354 now to urge your senators to support S. 1776 to eliminate Medicare payment cuts

"Medicare Physicians Fairness Act of 2009" would eliminate Medicare's sustainable growth rate (SGR) formula and protect seniors' and military families' access to care

S. 1776, the "Medicare Physicians Fairness Act of 2009," was introduced in the Senate this week. Senate leadership announced that the bill will serve as the Senate legislative vehicle for eliminating the SGR and laying the foundation for establishing a new Medicare physician payment update system through health system reform or other legislation. The bill would repeal the SGR permanently and set future payment updates at zero.

Importantly, the Senate leadership made it very clear that Congress does not intend to implement a permanent physician payment freeze and call it Medicare payment reform—and the AMA would not support such a proposal. Rather, by passing a separate bill that repeals the SGR and eliminates the accumulated spending target debt, budget constraints that have stopped permanent Medicare reform in the past would be lifted, allowing a new physician payment update system to be incorporated into a broader health system reform bill.

The first step to passing this bill will come quickly—as soon as Monday afternoon in fact. On Monday, Oct. 19, there will be a "motion to invoke cloture." That means there will be a vote to allow formal consideration of the bill. The key thing to remember is that we need 60 senators to vote with physicians and patients and vote "yes" on cloture. A vote on final passage is expected to occur next Thursday, Oct. 22, or Friday, Oct. 23.

Call (800) 833-6354 now and urge your senators to support S. 1776. This bill would not only stop the Jan. 1, 2010, Medicare cuts of more than 20 percent, it also would repeal the flawed SGR payment formula and start us down the path toward ensuring that physicians can continue caring for Medicare patients.

AAPI Legislative Day - April 23, 2008