How the Healthcare Reform Bill May Affect the Docs
By Alan Lyndon
President Obama’s efforts for massive healthcare reform endured a predictable setback in July. With so many moving parts, Obama’s chances of fast-tracking reform before the August recess were small. For physicians, the meat of the bill is being buried in the press coverage and appeals to voters.
In late July, the president went live on primetime for the fourth time in his six months in office – this time in an attempt for one last push to the public and to Congress to pass healthcare legislation prior to a self-imposed August 7 deadline.
“As we rescue this economy from a full-blown crisis, we must rebuild it stronger than before,” said President Obama. “And health insurance reform is central to that effort.”
According to the Kaiser Family Foundation, a nonpartisan health policy group, spending on health care totals about $2.5 trillion, 17.5 percent of our gross domestic product, which is a measure of the value of all goods and services produced in the United States. That’s up from 13.8 percent of GDP in 2000 and 5.2 percent in 1960, when health spending totaled just $27.5 billion – barely 1 percent of today’s level.
Health care has been “one of the few engines of job growth during the recession,” said Drew Altman, president of the Kaiser Foundation. Employment in the huge health care sector has grown by about 427,000 jobs – nearly 3 percent – since the recession began in December 2007, according to the most recent U.S. Bureau of Labor Statistics figures.
In his July address, President Obama slightly altered his emphasis from an all-encompassing overhaul of the healthcare system to a push for “health insurance reform.” Of the four major components of the healthcare system – physicians, patients, hospitals and insurance companies – Obama began to redirect his message by placing the spotlight on the insurance companies.
“I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, ‘What’s in this for me?’” Obama asked.
The more important question, for our purposes, is how will America’s Affordable Health Choices Act (H.R. 3200) affect physicians and their practices? To paraphrase the president, “What’s in it for you, the doctors?”
The bill is over 1,000 pages long and contains many proposals with few details. Thomas Miller, resident fellow of the American Enterprise Institute and former senior health economist for the Joint Economic Committee, suggested that such a complicated bill would be more difficult to pass through Congress. “The most dangerous parts of the bill are the embedded regulations to come,” said Miller in reference to the lack of detail and ability to change the bill after passage.
The full text of the bill can be read here.
Following are the major proposals included the H.R. 3200 that will most directly affect physicians and hospitals:
PROMOTING ACCOUNTABLE CARE ORGANIZATIONS
An “accountable care organization” is an organized group of physicians who are rewarded for providing high quality care at low cost over a sustained period of time. Section 1301 directs the Secretary to establish a comprehensive ACO pilot program and authorizes the continued expansion of the program where it proves successful in improving quality and keeping costs under control.
PROMOTING PAYMENT BUNDLING
Hospital and physician incentives can be restructured by paying a lump sum for an episode of care (“bundling” payments), rather than paying separately for each service provided. Section 1152 directs the Secretary to establish pilot programs to test the effectiveness of payment bundling across the nation in a wide array of formats so we can learn the best way to bundle payments to encourage efficiency and ensure quality.
REDUCING HOSPITAL READMISSIONS
Section 1151 uses new financial incentives to encourage hospitals and post-acute providers to undertake reforms needed to reduce preventable readmissions, which will improve care for beneficiaries and rein in unnecessary health care spending.
REWARDING HIGH-QUALITY AND EFFICIENT CARE
Section 1162 provides for increased payments to Medicare Advantage plans that demonstrate high quality of care and outcomes and plans that significantly improve quality. Section 1123 increases Medicare rates by 5% in the areas of the country that provide the most efficient care.
PROMOTING THE “MEDICAL HOME” MODEL
Section 1302 directs the Secretary to establish a pilot program to reward physicians and nurse practitioners who make their offices a “medical home” for patients by being fully available to patients and by ensuring that patient care is coordinated and comprehensive. The Secretary is authorized to expand the medical home concept if it proves effective in improving quality of care and holding down costs.
PROMOTING “SHARED DECISIONMAKING”
There is evidence that providing patients with more information about the risk and benefits of treatment options can help keep health care costs down and ensures that patients are fully involved in the care they receive. Section 1235 directs the Secretary to establish a demonstration program to evaluate the benefits of having doctors spend more time consulting with their patients about various treatment options.
PROMOTING PRIMARY CARE
Primary care providers can provide lower cost and higher quality care for many ailments. Section 1303 increases payment rates for primary care physicians by 5% and provides an additional 5% payment increase for primary care physicians in health shortage areas. Section 1121 provides for preferential updates for payment rates for primary care services in Medicare. Section 2212 expands scholarships and section 2211 creates a new loan repayment program to train more primary care physicians. Section 2201 builds on current expansions to the National Health Service Corps to get more physicians to health shortage areas, and this expansion in the Corps could eliminate 40% of the current estimated deficit in primary care providers. Sections 1501 and 1502 encourage more training of primary care medical residents and advance training in the outpatient setting, where most primary care is delivered.
DISCLOSING FINANCIAL RELATIONSHIPS
Section 1451 reflects MedPAC (Medicare Payment Advisory Commission) recommendations that all manufacturers of drugs and devices should report their financial relationships with health entities, including physicians, pharmacies, hospitals, and other organizations. MedPAC has concluded that such relationships can create conflicts, which lead to increased spending and suboptimal patient care.
UPDATED PAYMENT RATES
MedPAC has identified areas of overpayment to skilled nursing facilities, inpatient rehabilitation facilities, and home health care providers. Sections 1101, 1102, and 1154 adopt these payment changes to ensure we are spending taxpayer dollars appropriately. Sections 1103, 1131 and 1155 embrace the President’s recommendation to adjust payments so that providers are encouraged to increased productivity in how they deliver health care.
HEALTHCARE ASSOCIATED INFECTIONS
Section 1461 requires that hospitals and ambulatory surgical centers report public health information on healthcare associated infections to the Centers for Disease Control and Prevention. Section 1751 expands to Medicaid the current Medicare policy of denying payment for certain healthcare associated infections.
MORE AND BETTER HEALTH CARE DATA
The transition to a more efficient, higher-quality health care system begins with getting more data about the clinical effectiveness of medical procedures. Section 1401 invests $2.9 billion in comparative effectiveness research. Sections 1124, and 1441, 1443, 1444 and 1145 expand physician and hospital reporting of quality measures. Section 2531 creates a registry to track the use of medical devices. Section 1442 directs the Secretary to develop improved measures of health care quality. Section 2402 creates the Assistant Secretary for Health Information to provide for ongoing monitoring and reporting on critical population health data.
DEVELOPING NEW INNOVATIVE PRACTICES TO IMPROVE QUALITY
Measurement of quality is only useful if there are levers for change. Section 2401 creates the Center for Quality Improvement at the Agency for Healthcare Quality and Research in order to identify existing best practices, develop new best practices, and disseminate successful models around the country.
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In my belief, the natioanl health care issue will only be resolved if:
1) Compleat transparancy is exercised in terms of how the “matched medicare” payroll deductions [employee and employer] are utilized.
What happens to those matched funds? How much of the fund pays for medical residency training programs at designated teaching hospitals as a “pass through” accounting item?
2) The medical profession must utilize less expensive non-invasive, outpatient procedures for evaluating cerebral and peripheral circulation in nursing home patients. The present discriminating regulations reqire Ultrasound technology and do not permit other non-invasive procedures that have been utilized and funded by CMS for many years. Ultrasound technology has not been fully proven and is not cost effective. I would welcome an opportuity to discuss this issue with someone who would be interested in learning about a non-invasive system that precedes Ultrasound and is cost effective!
3) The general statement that health care will be for “everyone” will never happen as long as the attitude and policy of CMS continues to refused financial responsibility for early managements of chronic vascular conditions. This attitude by TriCenturian and other offices that denies coverage for procedures considered to be “screening’ is archaic. Chronic vascular conditions are not mysteries. Early recognition and mangement saves money and improves quality of life.
The contract with TriCenturion and CMS should be cancelled. That contract has been and is a costly mistake for providers. TriCentruian’s decisions have denied providers of deserved millions of dollars at the expense of needed care for designated patients. TriCenturian staff are not stupid, they are ill-informed and practice medicine from remote offices. the government saves money at the expense of patients!!
4) More to home – the Denison office that processes Medicare claims should ONLY process claims from TEXAS!! The Medicare regions served by Denison, Texas includes Oklahoma, New Mexico, Colorado as well as Texas. Parts of Arkansas, Louisianna and Arizona may also be included. This is a major diservice to Texas Providers and promotes a severe delay in patient health care for Texas. Let those other States take care of their own. The CMS office, as currently configured is not the “golden standard” for health care despite the tributes paid to CMS by political sources.
5) What percentage of uninsured hopital emergency room patient care is computed in the total national “welfare” cost? This uninsured emergency patient population cost is a financial disaster!
What isn’t in the bill will affect physicians to a greater degree. There is no SGR fix, no liability reform and no reasonable way to fund it. Where are the fundamental public health initiatives to reduce obesity, tobacco usage and preventable injuries and death? Granted these result in long term savings but what the heck, shouldn’t we be concerned with generations and not just a budget or election cycle?
There will never be true health care reform unless and until there is tort reform with NATIONAL caps on non-economic malpractice awards and a significant decrease in malpractice insurance premiums.
There will never be significant savings in health care costs until ownership and usage of imaging equipment is FORBIDDEN to all except those who are certified to operate it and interpret the studies –NO F***** loopholes.
Many Americans are stunned by what our President and Congress wants to deliver
for health care for our country. The lack of physician voices, and reticence to
contact our Representatives results in our silence as tacit approval.
Obama and Pelosi recently called doctors “greedy”. This is a new tactic imposed
to silence dissenting voices. Health-policy Adviser at the Office of Management
and Budget, Dr. Ezikel Emanuel, has claimed that we take the Hippocratic Oath
too seriously, “as an imperative to do everything for the patient regardless of
the cost or effects on others” (JAMA, June 18, 2008). As our patient’s
advocate, we are on higher moral grounds than anyone sitting in Washington. Many
of us have given sacrifices and trained for many years to be able to practice
our craft. It is time that we speak up for our patients and stop living in a
vacuum. We should not underestimate our position in the society and impact of
our opinion on all Americans.
From R. Dave MD
Overhauling the healthcare issue is relatively easy. Eliminate mandated employer health insurance. This would allow a uniform pricing in policies. Indiviuals will be able to shop more effectively for healthcare and develop the policies that they desiore. Think of shopping for a car and which amentities that the buyer desires. The patient can modifiy their policy according to the needs. Most are already paying partial premiums at work anyway. The free market will drive down costs. Next eliminate third party payment. The patient should pay the doctor directly and submit an invoice to their insurer. The patient can then decide if they are getting the quality of care for the cost. If they are disastified they can switch doctors. If they do not like the remitance from the insurance then they pick new policies or insurers. Both will be adequately drive by free market. The financial burden may actually change behavior which would improve health.
Tort reform is not included in this bill AND no one can answer my question regarding physicians being required to participate in a national health corps or losing their license.
This article refers to the Kaiser Institute as non-partisan. They, unfortunately are non-partisan in the sense that they have found the answer to medical care management and they desire not to consider any other format. I practiced in the Palo Alto, Menlo Park, Redwood City area for 25 years. Our group of cardio-vascular physicians had multiple interfaces with the Kaiser Group through patients referred because they could not or would not managed the difficult ‘outlier’ problems. This included retirees who had been told that they were just old and had to live with their circulatory insufficiency to resident moon-lighters who were told not to make a diagnosis on the charts because diagnosis requites intervention and that costs money. It should be noted that Mr. Kennedy’s concepts of universal healthcare are derived from the financial success of the Kaiser Group, in particular compared to the massive failure of the Blue Cross Blue Shield California group, At one time our hospital had not received any BS-BC payments for services completed for one year. Any thought that the government will do any better is sheer folly. Capture of control of the ‘Health Industry’ has been a political goal of the Progressive movement since Edwin Witte wrote FDR’s Old Age Subsistance and Universal Healthcare Bill in 1935.
On about page 640 of the House bill is a section that defines “Primary Care Physician” as an MD, DO, NURSE PRACTIONER, or supervised PA trained in primary care.”With apologies to NPs and PAs, they are NOT Physicians, but the current Administration would LOVE to make them interchangeable with Physicians, to dilute what little political clout we have. I guess I wasted 4 years in medical school, and 3 years residency!
I am concerned about this bill. I currently practice physical therapy and have my own practice. The amount of time I spend dealing with insurance companies unpaid claims is ridiculous. Also with the current Medicare B cap system some patients are never able to reach maximum functional potential and as a result may end up injuring themselves again and costing the government more money. The current system biggest problems are the insurance companies ripping off the patients, not paying providers appropriately, and the Medicare B cap. The insurance companies annually increase their premiums every year and pay us providers less and less every year. I believe if the government created an insurance program that offered lower premiums for the patients, less complicated billing procedures, and reasonable reimbursement to providers the other insurance companies would fall in line. The reason is providers and patients would have incentive to participate with the new program and as a result would drop all the current insurance companies that pay us 20 – 30 % of what we bill. Also I believe the government should pay for uninsured emergency visits, since this a problem at hospitals. We all went to school and spent a $100,000 plus in education along with sleepless nights and unbelievable stress why should we be penalized for our hard work. We all strive the best for our patients, so I hope they stop attacking the providers and start by dealing with the insurance companies.
I appreciate the apologies to NP/ PA’s. I am one, military trained and practicing since 1992, now in a Rural Health Clinic. I have trained Family Practice Residents in clinical Medicine, and most of my supervising Physicians in the military had less clinical experience than I did. I stayed in Primary care/ Family practice to care for the whole body and family. I am disgusted to see the American Academy of Physician Assistants endorsement of this Healthcare Reform, just because it includes Mid-level providers. I was trained as a Primary Care Manager in a Socialized Medicine System- the military. It doesn’t work. I refuse to endorse such a reform, I do agree that a “Health Care home” is needed, but the move to specialize has left a hole in Primary Care, that will have to be filled by someone. I have read and studied Healthcare policy and reform. Without Insurance reform, tort reform and tax reform first (fairtax.org), there will be no true health care reform.
You all need to read Sectio 261 because I think it could have an impact on malpractice. You might not be so quick to support Obama and his minions. It is around page 145, and here is what it says:
SEC. 261. CONSTRUCTION REGARDING STANDARD OF CARE.
(a) IN GENERAL.—The development, recognition, or implementation of any guideline
or other standard under a provision described in subsection (b) shall not be construed to
establish the standard of care or duty of care owed by health care providers to their
patients in any medical malpractice action or claim (as defined in section 431(7) of the
Health Care Quality Improvement Act of 1986 (42 U.S.C. 11151(7)).
So, it appears you will be in a catch-22: face potential malpractice by following govt. guidelines on what is the “best” treatment and is approved for payment, even if it is not consistent with the standard of care in the medical community, or treat a patient according to the standard of care in the medical community and not get paid or even get penalized for overtreating because the treatment was not approved by the govt. How can any doctor actually support this bill?
Going from military to civilian practice several years ago has opened my eyes to a whole host of perplexing issues. My biggest pet peeve has to do with 3rd party payers and “my overhead at about 62%”; most of which is directly related to doing the work of the insurance companies on behalf of the patient. Also the daily expectations of patients that I should know what is or is not covered by THEIR insurance plan. The silly game of “Pre-authorizations/PA’s” for medications is another splinter under my fingernail..”the pharmacy said I could get this if you just called my insurance company”, which translates into at least 30 minutes on the phone and 15 pages of paperwork for me. No other business I am aware of has to deal with this CRAP. My analogy is if your pipes burst in your house, you call the plumber; he fixes your leak and hands you a bill. He could care less if you have homeowners insurance or not, much less who it is with or what it may or may not cover. You would also never expect your plumber to have to get on the phone and hagle with your homeowners insurance representative as to whether he can install PVC#6 or PVC#8. You would never expect his office to have to hire a host of billing staff to file your claim for you either. Hell, I should have been a Plumber……………
Dismayed DO #8 – Have you read this bill? I have and can tell you that with all of the bureaucracy being created, you are going to be going through the same, if not worse. The only difference is instead of an insurance company, you will be dealing with the govt. Did you know that the govt. is going to do studies to decide what is the most effective care and you could not get paid for not following that? I think you might even get fined or have to face a board to explain why you didn’t? I think you might even face losing your license. READ THE BILL. I think the Section I cited should be enough to make you afraid. Maybe you have been subject to malpractice yet, but when you are placed in the position of deciding whether to get paid by following govt. guidelines for the most effective treatment versus following the standard of care established by the medical community, what are you going to do? Follow the govt. and leave yourself open to malpractice or do what is right and face not getting paid or even “getting in trouble” with the govt.?
I think we will all (PAs and NPs) see our salaries go down due to the glut of mid level practitioners in general along with RNs and other “ancillary staff”…rad techs, respiratory therapists, physical therapists, etc. since reimbursement to hospitals and MDs will drop they can’t afford to pay us as much. Also they will force us to take a financial hit before they will accept one. You will also see a HUGE movment to use “techs” which essentially are non-licensed people hired off the streets with little or no medical experience to do work at a pittance of a salary. This is essentially what people mean when they say the quality of health care will go down….and they are right, since more of it will be provided for by people with no actual licenses or medical experience. This is already occurring a lot in nursing homes where care is provided for by “techs” who are overseen by one RN. You also WON’T see any of the benefits reform could have taken such as ordering meds from foreign countries more cheaply. The government and pharmaceuticals are in bed together and have a choke hold on any threat to that arrangement ever occurring. I’m usually not an alarmist but the overall debt of this administration along with the taking over of nearly every aspect of society, including now health care (roughly 1/5 the economy) scares me.
As a prospective medical student, I am frankly extremely confused as to what my future as a physician could turn out to be. I’ve read a large number of articles but nothing truly lays out what this “reform” will look like. Everything from the white house says that this reform will increase coverage and insurance options. However, there is very little about how this will affect physicians. If anyone has some objective information on this topic I would greatly appreciate it. Will the payment system be the same? Will the government’s “public option” be billed the same way as any other insurance company? Is there anything about a minimum that insurance companies must pay providers for specific services?
Let’s not put all the blame on the lawyers and pharmaceutical companies for this health care disaster. I’ve worked with more than a few greedy doctors in my lifetime, so don’t think the majority of them actually care about their patient’s health and welfare. From what I’ve witnessed, the majority of them care far more about their pocket book.
Obama hit the nail on the head when he commented that doctors were greedy, because the MAJORITY of them are! If the state medical boards witnessed what I have, there would be far fewer doctors. What’s really sad, is that physicians won’t report the unethical ones, even though they know they’re harming patients!
It’s almost laughable that physicians are so adament about NP’s needing their “supervision.” From what I’ve witnessed, nurses need to supervise DOCTORS and protect patients from them.
2/26/2010
One would say that people who have the abilty to read these Laws, Government Officials failter, as when The United Nurses ORG. step in over a issue found and it set back this Bill for Law,
2/26/2010
Wow, It was stated that Health care is not a moral issue,hmmmm
Please allow me to share a little story with you. As I watched my mom die from cancer, and Health care Insurance Companies dumped on her as if she was no more than a dog dieing on the side of the road, i dropped from and out of this system for over 30 years, and now because of system failure, the IT, has come into my life. As I watch Government Officials fight over this Health care Dollar, it reminds me of a bright sunny day in Tennessee while on a friends farm and a little bug flew in to the ground, and the chickens went plum off, boy oh boy the scawking and the feathers went shy high, so I reached down and I took this scared little Health Care Bug from Government Officials, and I have it safely in my hands. As I searched for a way to help, I asked God to help me build a Reform that is of a moral building block for the better good of man kind and to rebuild the National Security of the United states Of America. And you would never guess what God has allowed me to see. This little blog statement you will find true,
first;
I wish to give a great big thank you to all my new friends on the Internet for posting FASC Concepts in and for Pay It Forward.
This building block for a honest Health Care Reform has been a great experience and for any one who did not take part, you have truly missed out on what makes Americans Great. This diversity created by Government Officials has failed and now the eyes of 173 million American People watch as now, for the first time Government Officials sit down together as it should be. The out come is yet to be seen. But they know that a anomaly has been created and it is because of the restructuring of The Constitution, The Bill Of Rights, and The Declaration Of Independence, “has been used in it original created forum” as a factor of a peoples right to undo the amendments of Laws that protected Health Care Companies against the People, over a dollar.
And I wish to say i write what is needed in order that some how I can undo all the wrong I have done in hopes that the slate will be wiped clean….
Just because our children do not understand I wish to share this again,
“For days I worked the word diversity in my mind and it came to me that because of this it is not Americas weakness it is our greatest strength. And this is how I will show you.
Constitution-
Bill Of Rights -
The Declaration of Independence-
United under one forum, builds what is called the Trinity of the Protection Of Laws. This is because these Laws were built by people of faith who gave thanks to God for this wisdom. One would have to see and admire the simplicity of the three as one and at the same time they maintain their independence.”
On page 100 at our site is the early stages of what is called A Prime Directive for Health Care, so please drop on by and see 173 million peoples views in and for Health Care. And it should be known that this information on page 100 is true and documented in Law and History.
Henry Massingale
FASC Concepts in and for Pay It Forward
I find it amusing that some docs have an issue when the term “Primary Care Provider” is used instead of “Physician”. As an NP it never was my intent to replace a doctor. I was trained in primary care and feel that within that realm of medicine I function very well. The fact is that most docs do not go into the area of Family Med/primary care due to various reasons (pay, patient load, etc…). NP’s ( and PA’s) have stepped into that gap and provided quality primary care with good rates of patient satisfaction. There are many studies that document this. In the future I think we will continue to see the movement of NP’s and PA’s performing primary care and physicians going into specialties. I just wish we could do away with the bickering that goes on between the AMA and Nursing Organizations. We are all after the same thing, providing care to improve the quality of a patient’s life. Also, I despise the term “mid-level”. What the heck am I “mid-level” to? It is a very degrading term.
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