Posted by Guest Blogger on Mon, Dec 07, 2009 @ 02:27 PM
By Joel A. Stettner, M.D.
Enacting a healthcare reform bill is obviously a very complicated, methodical and political process. Personally, I don't mind vigorous and open debate on legislation that has the potential to dramatically affect physicians, hospitals, insurers, and patients.
What I do mind is the inability of the House and Senate to find some middle ground and hammer out a bill. You know the drill: the Democrats, barely in charge based on votes, propose legislation - but not until many of the true reforms are removed to please the "Blue Dogs". However, that doesn't sit well with the liberals in the party, who balk at attempts to "gut" alternatives, such as a public option, out of the bill.
And then there are the Republicans - who give new meaning to the word "no". They're not budging - and they're not helping to reach the afore-mentioned middle ground. After all, the "base," or what's left of it, must be satisfied.
What's more, both parties are obligated to those many special interests that are able to buy access and peddle influence.
But now, AARP has re-entered the fray. Could this be the needed impetus to help the Democrats take advantage of their 60 seat majority in the Senate - and actually pass a bill?
According to this Associated Press article, last week the AARP "rode to the rescue" of Democrats, supporting $460 billion in Medicare cuts to help pay for health insurance legislation. AARP has played an influential role all year on health care, working with the Obama administration and Democratic congressional leaders to help pass legislation. Polls show them enjoying a large amount of trust among seniors - who tend to vote - which means their endorsement is highly regarded.
And so we wait - stuck in a political process that does not seem to change, with the concept of "bipartisanship" as elusive as ever. Lobbying reform apparently has had no real impact, and special interests, including AARP, continue to hinder meaningful reform while the number of uninsured Americans continues to climb.
Well, sooner or later something will happen. In the meantime, you might take a look at this article, which appears in HealthLeaders Media, which explains how we're going to pay for whatever is in the final bill.
I look forward to hearing your thoughts.
Posted by Guest Blogger on Fri, Dec 04, 2009 @ 05:03 PM
By Ellis Weeker, M.D.
Last Friday, the Centers for Medicare and Medicaid Services (CMS) released the 2010 Physician Fee Schedule Final Rule. The agency is announcing that unless Congress intervenes to prevent the cut from occurring, there will be a 21.2% reduction in the Medicare physician fee schedule conversion factor, effective January 1, 2010.
This proposed reduction is due to Congress failing to permanently address the Sustainable Growth Rate (SGR) formula used to calculate annual updates in physician payments under Medicare.
At present, Congress is debating various ways to address the SGR problem but as of this writing, they have been unable to pass legislation. It's possible that Congress could include a temporary fix in the healthcare reform legislation, but nothing is set in stone at this point. If Congress fails to rescind the SGR cut before early December, it's possible the cut could take place only to be rescinded later as has happened in the past.
The challenge is not coming up with an alternative to the SGR formula, but figuring out how to pay for the fix. According to the Congressional Budget Office, simply freezing physician payments for the next 10 years, in lieu of the scheduled cuts, would increase the deficit in the Medicare Trust Fund by more than $240 Billion over the next 10 years.
While it's likely that Congress will take action to prevent the 21.2% cut from taking place, it's still not certain. Click on this link to voice your concern to strongly encourage Congress to fix this situation soon enough to prevent the types of administrative problems that occurred a few years ago - when Congress rescinded the SGR cut after it had already taken effect.
This is an important time to let your voice be heard, so please take a moment to contact your Senator and Representative today.
Posted by Guest Blogger on Fri, Dec 04, 2009 @ 05:00 PM
By Wesley A. Curry, M.D.
I'm not the first healthcare professional to point out that this country already has variants of a "public option" in health care. The Senate's latest rendition will hopefully reverse a trend and not further burden hospitals and ER physicians with more uncompensated care. But the fact is any new program will be the "fifth" public option since 1965. And each one has ultimately increased the economic challenges on the emergency care system.
The existing public option variants are Medicare and Medicaid, both established in 1965 and both obviously financed by tax payer revenue. Another is the Health Maintenance Organization Act of 1973, which gives HMOs certain economic advantages including the ability to force non participating physicians and hospitals to accept lower reimbursement for treatment of HMO patients. Lastly there's the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, an unfunded mandate that ensures public access to emergency services regardless of the individual's ability to pay.
Medicare and Medicaid patients are becoming less desirable to healthcare providers because of decreasing reimbursement rates (legislated decreases or because rates have failed to keep up with inflation). That means more people are coming to hospitals under the mandates of EMTALA. The problem is, it remains unfunded and is the "last resort" for people without health care. Their default option then becomes the hospital ER.
Emergency care providers and hospitals can ill afford to have another "public option" that does not adequately reimburse primary care physicians and specialists. Increasingly hospitals have had to make up the difference and provide financial support for emergency care providers and on call physicians. Some hospitals have closed and the number of emergency rooms has dropped nationwide as the average reimbursement continues to decrease for patients in emergency rooms.
A fifth public option is a good thing for the country - but only if more people get access to primary care. The covered services must be limited and tort reform needs to be included, because whatever form the public option takes, the benefits won't be equivalent to the best commercial insurance plans which are quite expensive in comparison. With more people covered by medical insurance, the rise in cost will be mitigated if the hospitals and health care providers don't have to factor in significant losses from uninsured and underinsured patients. There is no free lunch and no free health care. I would appreciate hearing your thoughts and comments.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 04:53 PM
By Marty Ogle M.D.
As emergency physicians and healthcare professionals, healthcare reform - whatever it ends up looking like - will affect our practice, our hospitals, and our patients.
Even though Congress is now in recess, its members are meeting with constituents around the country (as you've likely seen in the news). Congressional leaders are also currently crafting key healthcare reform bills to be considered in September.
So now's the time to contact your Senators and Representative, letting them know your healthcare reform concerns. One of the easiest ways is to go to the MGMA Advocacy Center to tell your representatives to finally repeal the Medicare physician payment formula and tell them not to link new payment systems to this flawed update system.
It's also important to encourage them to include administrative simplification proposals to reduce costs.
While you're at it, be sure to remind them that as your elected representatives, they should not delegate authority to make important Medicare-related reforms to a non-elected entity.
With the heated and oftentimes irrational discord going on at the moment, it's easy to lose sight of the fact that true healthcare reform is necessary, is prudent - and there are serious issues that will affect us as practicing physicians. Having your voice be heard is more important than ever right now!
Send Congress an email now and let's keep the healthcare discussion on track.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:23 AM
By Rodney Borger, M.D.
Well, the August Congressional recess has temporarily quieted the health care debate in Washington, D.C. But many doctors like me remain focused on how possible health care reform could affect our local public hospitals.
Lawmakers will soon resume the battle over how to expand coverage and how to fund it, but there is another pressing issue that doctors like me are very concerned about. It involves making sure our hospitals, doctors and nurses can continue to provide timely, quality emergency care to anyone who is admitted to one of our emergency rooms.
Right now, our ERs are in jeopardy of losing an important funding source from the federal government - funding that it has an obligation to provide.
Without the federal reimbursement that the 2003 Medicare law provides, our hospitals and health providers will simply not be able to offer the quality of care expected in our emergency rooms. That means patients will no doubt have to wait longer for treatment in increasingly overcrowded waiting rooms because of facility closures and staff and supply shortages.
Last year the campaign to extend Section 1011 had bi-partisan support. Today (a year later) I fear the issue may be overshadowed in the larger health care debate. I'm urging our representatives to consider the consequences of halting federal reimbursement for emergency care at a time when the need for care is greater than ever.
Extending Section 1011 funding is an issue that affects everyone who works in emergency rooms as well as those who may one day need emergency care. Your help is needed.
We need to act now! Please contact your federal representatives and urge an extension of Section 1011, so that we can continue to provide quality emergency medical care to anyone who needs it. If you have additional thoughts or suggestions, please send a comment - I'd love to hear them.