Monday, October 31, 2011
Friday, October 28, 2011
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Thursday, October 20, 2011
Tuesday, October 18, 2011
Monday, October 17, 2011
Friday, October 14, 2011
Thursday, October 13, 2011
Physicians Lobby Hard Against Payment Formula
Physicians Lobby
Hard Against Payment Formula
By Rebecca Adams, CQ HealthBeat Associate
Editor
The payment formula, which most lawmakers agree is flawed, would result in a nearly 30 percent cut in January for physicians if Congress does not block it. In most years over the past decade, lawmakers have staved off the cut temporarily through short-term measures that exacerbate the long-term costs. The 10-year price tag for repealing the formula would now total about $300 billion.
AMA officials are lobbying heavily to persuade Congress to include a major fix to the problem as part of any deficit reduction deal that might emerge from the Joint Select Committee on Deficit Reduction, known as the “supercommittee.” Physicians have scheduled meetings with supercommittee members and physicians who serve in Congress as well as their own representatives.
“Urge them to promote the message that a permanent fix to the physician payment system should be part of any solution to address the budget deficit — failure to act only leads to increased costs in the future,” reads an AMA alert to members.
The television ad campaign started Oct. 7 and will run for two weeks on the national cable television channels CNN and Fox and on broadcast television channels in different markets throughout the nation. A 60-second radio ad also will run in several cities for 10 days. The AMA also commissioned a poll that told 1,000 adults that Medicare payments have been stagnant for a decade, are scheduled for a 30 percent reduction and that “about 1 in 5 doctors say they are already being forced to limit the number of seniors they can care for because of Medicare’s broken physician payment formula.” The poll found that 94 percent of people found the situation very or somewhat serious. The margin of error was 3.1 percentage points.
The AMA campaign comes as other groups, such as the American Osteopathic Association, run ads of their own on the issue. The AOA launched a six-figure campaign with ads on inside-the-Beltway health and political Web sites until Nov. 23, when the supercommittee’s recommendations are due. Radio ads are also running in states such as
Changing the formula is complicated by its
massive long-term costs and the offsets that would be needed to pay for it.
Recently, the Medicare Payment Advisory Commission (MedPAC) was hit with a
swarm of complaints when it compiled a list of potential cuts to Medicare
providers that could be considered as options to fund a major change in
physician payments.
Wednesday, October 12, 2011
MedPAC Approves Physician Payment Plan, Overlooking Concerns About Offsets
MedPAC Approves Physician Payment Plan, Overlooking
Concerns About Offsets
By Rebecca Adams, CQ HealthBeat Associate
Editor
Even the American Medical Association (AMA), whose top priority is to eradicate the flawed formula, opposes MedPAC’s proposed fix.
“Offsetting part of the cost of repeal through drastic cuts and long-term freezes to physicians falls far short of what is needed to preserve patients’ access to care,” AMA President Peter W. Carmel said in a written statement.
Almost all health policy experts agree that the physician payment formula, known as the sustainable growth rate (SGR), does not work as intended. Congress has repeatedly staved off scheduled cuts in physician rates that were set by the formula. But the cost of permanently fixing the problem grows with every temporary reprieve. In January, the formula would result in a nearly 30 percent payment cut for physicians if Congress does not vote to prevent it.
The MedPAC recommendation would replace the problematic SGR formula with a 10-year fee schedule that would freeze primary care payment rates and cut rates for other providers by 5.9 percent for three years before freezing those payments as well. MedPAC included a list of offsets totaling $220 billion over a decade that Congress might consider to pay for the new physician payment rates. About 34 percent of the funding for the changes would come from the drug industry; 21 percent from post-acute care, such as skilled nursing facilities and home health agencies; 15 percent from higher cost-sharing by beneficiaries; and 11 percent from hospitals.
Representatives of medical providers — who packed the room so tightly that a number of people had to stand — were not happy with the proposed cuts. They had expressed concerns about the proposal when it was unveiled. Several groups had written letters also opposing the plan.
Only two commissioners — Karen Borman, director of the Surgical Residency Program of Abington Memorial Hospital in Pennsylvania and Ronald Castellanos, a urologist with Southwest Florida Urologic Associates — voted against the MedPAC recommendation.
Castellanos noted that under the plan, a nurse practitioner would be eligible for higher Medicare payment rates than a physician specialist, a prospect that he called “extremely disturbing” because he said the average urologist has undergone about 17,000 hours of training while a nurse practitioner has had no more than 1500 hours.
Castellanos said that specialists who face a growing number of government regulations and declining payment rates are going to ask themselves: “Is it worth it for me to stay in practice?
“I think there are going to be a lot of doctors like myself who are going to say it’s just not worth it anymore,” he added.
During the deliberations on the plan, many commissioners expressed reservations about the proposal, especially the offsets.
Several said that the list of offsets should not be seen as a recommendation from MedPAC that Congress consider those specific policies to reduce spending growth. In fact, some said they had problems either with some of the precise offsets or with the overarching idea that all of the cuts should come from Medicare rather than other types of government spending. But all of those who voted to approve the recommendation said the time had come to finally stop passing one-year changes to the physician payment formula, and that goal overcame their reservations about the offsets.
In a PowerPoint presentation, MedPAC staff noted, “Offsetting the cost within Medicare compels difficult choices — both in offsets and in fee reductions — that MedPAC may not support outside of the context of repealing the SGR system.”
After the vote, lobbyists and other representatives of physicians and other medical professionals lined up to express their unhappiness. Even though most of them expressed support for ditching the current SGR formula, they argued that the costs should not be borne by Medicare providers. Many types of providers are already preparing for other cuts that were in the 2010 health care overhaul (PL 111-148, PL 111-152) and may face additional cuts if Congress passes them this year as part of legislation to reduce the deficit. Two speakers said the medical profession should not pay for higher-than-scheduled payment rates for physicians because providers did not create the flawed formula — Congress did.
“For almost everyone in this room, it’s been kind of a disheartening morning,” said Barbara Tomar, director of federal affairs for the American
The draft recommendations were:
• “The Congress should repeal the sustainable growth rate and replace it with a 10-year path of statutory fee schedule updates. This path is comprised of a freeze in current payment levels for primary care and for all other services, annual payment reductions of 5.9 percent for three years, followed by a freeze. The commission is offering a list of options for the Congress to consider if it decides to offset the cost of repealing the SGR system within the Medicare program.” Approved 15-2.
• “The Congress should direct the secretary [of Health and Human Services] to regularly collect data — including service volume and work time — to establish more accurate work and practice expense values. To help assess whether Medicare’s fees are adequate for efficient care delivery, the data should be collected from a cohort of efficient practices rather than a sample of all practices. The initial round of data collection should be completed within three years.” Approved 17-0.
• “The Congress should direct the secretary to identify overpriced fee-schedule services and reduce their RVUs accordingly. To fulfill this requirement, the secretary could use the data collected under the process in recommendation 2. These reductions should be budget neutral within the fee schedule. Starting in 2015, the Congress should specify that the RVU reductions should achieve an annual numeric goal — for each of five consecutive years — of at least 1 percent of fee-schedule spending.” Approved 16-1.
• “Under the 10-year update path specified in draft recommendation 1, the secretary should increase the shared savings opportunity for physicians and health professionals who join or lead two-sided risk ACOs. The secretary should compute spending benchmarks for these ACOS using 2011 fee-schedule rates. Approved 15-1, with one abstention.”
IOM benefits recommendations include premium target
IOM benefits recommendations include
premium target
Posted: October 6, 2011 - 6:30 pm ET
HHS should establish an essential
health-benefits package that is guided by a national average health plan
premium target, the Institute of Medicine recommended in a highly anticipated
report.
The IOM's nearly 300-page report is a response to HHS' request for the IOM's recommendations about the process the HHS secretary should use to define and update essential health benefits. Outlined in the healthcare reform law, essential benefits must be offered to individuals and small groups in state-based exchanges and the existing market. More than 68 million people will obtain insurance that must meet essential health benefit requirements, the report noted.
The IOM's nearly 300-page report is a response to HHS' request for the IOM's recommendations about the process the HHS secretary should use to define and update essential health benefits. Outlined in the healthcare reform law, essential benefits must be offered to individuals and small groups in state-based exchanges and the existing market. More than 68 million people will obtain insurance that must meet essential health benefit requirements, the report noted.
Related
Articles
Committee members who worked on
the report combined perspectives from four areas—economics, ethics,
evidence-based practice and population health—to create what the IOM called an
“overarching framework” for HHS. The committee then used that as a foundation
to develop criteria that could help guide HHS in its decisions, and sought to
achieve two aims: to provide coverage for a range of Americans, and to ensure
the affordability of that coverage.
Defining a premium target became a “central tenet” of the committee because, the committee concluded, if cost is not taken into account, the essential health-benefits package will become increasingly unaffordable for both individuals and small businesses. If that happens, the overriding purpose of the Patient Protection and Affordable Care Act—enabling people to buy insurance—will not be achieved. Determining just how to consider cost was a large task for the committee, which ultimately recommended that HHS determine what the national average premium of typical small employer plans would be in 2014 and then ensure that the package's benefits does not exceed that amount.
“This ‘premium target' should be updated annually, based on medical inflation,” the report said. “Since, however, this does little to stem healthcare cost increases, and since the committee did not believe the DHHS secretary had the authority to mandate premium (or other cost) targets, the committee recommends a concerted and expeditious attempt by all stakeholders to address the problem of healthcare cost inflation.”
America
“With this thoughtful report, the IOM is urging policymakers to strike a balance between the affordability of coverage and the comprehensiveness of coverage,” AHIP President and CEO Karen Ignagni said in a news release. “We agree that this balance is critical to ensuring that individuals, working families and small employers can afford health insurance. The recommendation that the initial EHB package reflect the scope of benefits and design provided under a typical small employer plan is an important step toward maintaining affordability.”
The IOM also recommended that for those states administering their own exchanges that wish to adopt a variant of the federal essential health-benefits package, the HHS secretary grant those requests—provided that they produce a package that is “actuarially equivalent” to the national package. To achieve this, the report noted, the HHS secretary should encourage what it called a “public deliberative process” that it described in the report. It also suggested that beginning in 2015, for implementation in 2016 and every year after that, the HHS secretary should update the essential health-benefits package with the goal that it become more fully evidenced-based, specific and value-promoting.
In an e-mailed statement, HHS Secretary Kathleen Sebelius said she appreciated the IOM's work and looks forward to reviewing the recommendations.
“But before we forward a proposal, it is critical that we hear from the American people,” Sebelius said in the statement. “To accomplish this goal, HHS will initiate a series of listening sessions where Americans from across the country will have the chance to share their thoughts on these issues.”
Defining a premium target became a “central tenet” of the committee because, the committee concluded, if cost is not taken into account, the essential health-benefits package will become increasingly unaffordable for both individuals and small businesses. If that happens, the overriding purpose of the Patient Protection and Affordable Care Act—enabling people to buy insurance—will not be achieved. Determining just how to consider cost was a large task for the committee, which ultimately recommended that HHS determine what the national average premium of typical small employer plans would be in 2014 and then ensure that the package's benefits does not exceed that amount.
“This ‘premium target' should be updated annually, based on medical inflation,” the report said. “Since, however, this does little to stem healthcare cost increases, and since the committee did not believe the DHHS secretary had the authority to mandate premium (or other cost) targets, the committee recommends a concerted and expeditious attempt by all stakeholders to address the problem of healthcare cost inflation.”
“With this thoughtful report, the IOM is urging policymakers to strike a balance between the affordability of coverage and the comprehensiveness of coverage,” AHIP President and CEO Karen Ignagni said in a news release. “We agree that this balance is critical to ensuring that individuals, working families and small employers can afford health insurance. The recommendation that the initial EHB package reflect the scope of benefits and design provided under a typical small employer plan is an important step toward maintaining affordability.”
The IOM also recommended that for those states administering their own exchanges that wish to adopt a variant of the federal essential health-benefits package, the HHS secretary grant those requests—provided that they produce a package that is “actuarially equivalent” to the national package. To achieve this, the report noted, the HHS secretary should encourage what it called a “public deliberative process” that it described in the report. It also suggested that beginning in 2015, for implementation in 2016 and every year after that, the HHS secretary should update the essential health-benefits package with the goal that it become more fully evidenced-based, specific and value-promoting.
In an e-mailed statement, HHS Secretary Kathleen Sebelius said she appreciated the IOM's work and looks forward to reviewing the recommendations.
“But before we forward a proposal, it is critical that we hear from the American people,” Sebelius said in the statement. “To accomplish this goal, HHS will initiate a series of listening sessions where Americans from across the country will have the chance to share their thoughts on these issues.”
Tuesday, October 11, 2011
Monday, October 10, 2011
Sally Goza, MD, Fayetteville and Avril Beckford, MD, Atlanta were elected to national positions at the American Academy of Pediatrics
Sally Goza, MD, Fayetteville and Avril Beckford, MD, Atlanta were elected to national positions at the American Academy of Pediatrics in elections which concluded on October 1.
Dr. Goza was elected as chair of District X and thus becomes a member of the Board of Directors of the AAP. The AAP board has 10 members; and District X is comprised of Alabama, Florida, Georgia and Puerto Rico. She serves a 3 year term.
Dr. Beckford was elected to the AAP Nominating Committee, which is charged with selecting nominees for the AAP president’s contest. She also serves a 3 year term.
In other election results, Dr. Jay Wiley of Alabama was elected District X vice chair. And in the AAP president’s race, Dr. Thomas McInerny of New York was elected. All of them will officially take office at next weeks AAP National Convention & Exhibition in Boston, October 14-16, 2011.
Docs, Hospitals Rip MedPAC on Physician Pay Proposal - CQ HealthBeat
Docs, Hospitals Rip MedPAC on Physician Pay Proposal
By Jane Norman, CQ HealthBeat Associate
Editor
Sternly worded letters from the American Hospital Association (AHA) and the American Medical Association (AMA), along with physician specialty groups, will be in MedPAC’s mailbox when the commission meets Thursday. The first item on the agenda is a resumed discussion of a Medicare doctor reimbursement formula that lawmakers, experts and providers agree is deeply flawed and repeatedly in crisis.
The $300 billion estimated cost of a fix over 10 years is a huge barrier to changing the formula at a time when a joint congressional committee is digging into entitlement programs in a search for ways to trim the deficit. MedPAC in September offered up a 10-year solution. But it’s clearly sticking in providers’ throats
MedPAC has no real power to get its recommendations implemented. And historically, MedPAC is a low-key panel that debates enormously complex health policy issues in relative obscurity. But the commissioners are finding themselves in the middle of a firestorm in recent months. Congress asked for MedPAC’s advice specifically on a fix for the physician pay formula, known as the Sustainable Growth Rate, and MedPAC’s ideas are frequently mentioned in various deficit cutting proposals. Thus those who are affected are reacting quickly and loudly.
In its Oct. 3 letter to MedPAC Chairman Glenn Hackbarth, the hospital group strongly objected to the notion that health care providers’ reimbursements should be cut to offset the costs of an overhaul of the physician payment system. The MedPAC proposal would freeze payments for primary care doctors and also cut specialist reimbursements for three years and then freeze them.
A grab bag of other ideas was put forth by MedPAC as well, with impacts on hospitals, home health patients and agencies, durable medical equipment, drugmakers and skilled nursing facilities
AHA President and CEO Richard J. Umbdenstock said the commission should instead look to beneficiaries for offsets, including increasing the Medicare eligibility age and eliminating first-dollar coverage in Medigap. In addition, the current medical liability system should be revamped to provide additional savings, AHA says.
But Sen. Bernard Sanders of
“We must keep our promise to provide Medicare at age 65 to American workers who have contributed payroll taxes to Medicare throughout their working lives,” Sanders wrote. “Raising Medicare’s eligibility shifts costs to seniors, employers and states, with the greatest burden placed on low-income seniors and those physically unable to work for two more years.”
The Umbdenstock missive also roughed up MedPAC for failing to adhere to what the AHA said is the usual process for considering policy options. Umbdenstock said that only $50 billion of the offsets MedPAC recently recommended to fix the formula were from actual commission recommendations, with the remaining $180 billion coming from Congressional Budget Office (CBO) projections and MedPAC staff estimates.
“Until now, MedPAC has followed a very rigorous process for developing recommendations that allows all commissioners the opportunity to fully deliberate recommendations and consider all their impacts, both intended and unintended, before voting,” he wrote.
In bold letters, he added: “It is inappropriate for the commission to suggest such impactful cuts when commissioners have not fully deliberated, received public comment or voted on these policies.”
He said that paying for an overhaul of the sustainable growth rate formula with Medicare cuts to hospitals and other providers is “robbing Peter to pay Paul” and “is the wrong approach.” While the commission’s main charge is to review and recommend improvements in Medicare, many activities in the health care marketplace in general affect Medicare, such as medical liability costs, he wrote.
The hospitals do support a draft recommendation by MedPAC to increase the shared savings for accountable care organizations that take part in a more risk-based ACO program.
The AMA had strongly criticized the MedPAC plan as soon as it was unveiled and followed up with a five-page letter on Oct. 3 signed by the AMA and more than 40 specialty physician groups.
The doctors said the MedPAC plan retains many of the current system’s faults, undermines physicians’ ability to take part in changes in Medicare payment and delivery systems and “calls for payment rates that the commission itself has previously said could reduce Medicare beneficiaries’ access to medical care.”
A longer list of potential offsets for the cost of the doc fix has been identified by other groups including the so-called Senate Gang of Six.
“MedPAC could and should tell Congress to rely on these existing proposals rather than offering up a new package that magnifies the size of provider and beneficiary sacrifices due to the limited scope of items within the commission’s purview,” the doctors said.
Thursday, October 6, 2011
Sally Goza, MD, Fayetteville and Avril Beckford, MD, Atlanta were elected to national positions at the American Academy of Pediatrics
Sally Goza, MD, Fayetteville and Avril Beckford, MD, Atlanta were elected to national positions at the American Academy of Pediatrics in elections which concluded on October 1.
Dr. Goza was elected as chair of District X and thus becomes a member of the Board of Directors of the AAP. The AAP board has 10 members; and District X is comprised of Alabama, Florida, Georgia and Puerto Rico. She serves a 3 year term.
Dr. Beckford was elected to the AAP Nominating Committee, which is charged with selecting nominees for the AAP president’s contest. She also serves a 3 year term.
In other election results, Dr. Jay Wiley of Alabama was elected District X vice chair. And in the AAP president’s race, Dr. Thomas McInerny of New York was elected. All of them will officially take office at next weeks AAP National Convention & Exhibition in Boston, October 14-16, 2011.
Wednesday, October 5, 2011
Sally Goza, MD, Fayetteville and Avril Beckford, MD, Atlanta were elected to national positions at the American Academy of Pediatrics
Sally
Goza, MD,
Fayetteville and Avril Beckford, MD, Atlanta were elected to national
positions at the American Academy of Pediatrics in elections which concluded on
October 1.
Dr. Goza was elected as chair of District X and thus becomes a
member of the Board of Directors of the AAP. The AAP board has 10 members; and
District X is comprised of Alabama, Florida, Georgia and Puerto Rico. She
serves a 3 year term.
Dr. Beckford was elected to the AAP Nominating Committee,
which is charged with selecting nominees for the AAP president’s contest. She
also serves a 3 year term.
In other election results, Dr. Jay Wiley of
Alabama was elected District X vice chair. And in the AAP president’s
race, Dr. Thomas McInerny of New York was elected. All of them will
officially take office at next weeks AAP National Convention & Exhibition
in Boston, October 14-16, 2011.
Monday, October 3, 2011
Senators push to let states opt-out of Medicaid expansion
September 28, 2011 @ Bailey McCann CivSource
States may be able to opt-out of expanding Medicaid coverage if two Senators have their way. Senators Lindsey Graham and John Barrasso introduced a bill last week designed to provide ‘Medicaid flexibility,’ for states. The Senators argue that Medicaid is a drag on state budgets and plans to expand the program under federal health care reform legislation will only exacerbate the problem.
17 million new people will be eligible for Medicaid by 2014 under health care reform. According to the Senators, expanding eligibility will only add to the financial burden already on state governments and they should be allowed to opt-out of the expansion of the program.
“I’m confident that if given the chance a large number of states would opt-out of Obamacare’s forced Medicaid expansion,” said Graham in a statement. “In
While, eligibility for a program is no guarantee that an individual will choose to join the program, the Senators feel even the option is too much. Senator Barrasso argues that increasing the state matching requirement will force states to pull money from other programs in order to meet these new requirements.
Critics of the bill in Congress say that letting states opt-out does nothing to address the problem of health care access for children and low-income individuals. In the Graham’s home state, nearly one in four people are on Medicaid now, many of them children. Even though federal health care reform legislation will open the insurance market overall, many people still do not earn enough from their jobs to afford insurance. Medicaid is there to provide access for these people and children.
The uninsured population in
The lack of alternatives makes the bill unlikely to advance in Congress, despite support from governors like Nikki Haley, who called the expansion a “disaster for
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