Download American College of Rheumatology

American College of Rheumatology
The Current State of
Health Care Reform
Aiken Hackett
Director, Government Affairs
Health Care Reform
Objectives
• 2010 Physician Fee Schedule
• Senate Health Care Reform
• House Health Care Reform
Medicare Physician Fee Schedule
2010 Proposed Rule
• Elimination of Consultation Codes
• Decrease of Infusion payments 25%
• Continuation of PQRI
Medicare Physician Fee Schedule
2010 Proposed Rule
What Is the ACR Doing?
• Submitting comments to CMS
• Working with other medical organizations and
advocacy groups
• Submitted op-ed articles to major newspapers
• Encouraging members to submit comments to CMS
and reach out to Congress
Medicare Physician Fee Schedule
2010 Proposed Rule
What Can You Do?
1. Submit letter to CMS by 5pm ET August 31
Letter Template Online at www.rheumatology.org and
instructions on submission
• Electronically at www.regulations.gov
• USPS
Center of Medicare & Medicaid Services
400 Independence Ave, S.W
Washington, D.C. 20201
2. Express your concerns with your members of Congress
Information can be found on the ACR Website at
www.rheumatology.org/advocacy under News Flash
ACR Position on
Health Care Reform
To ensure access to care, the ACR supports:
1) Access to affordable health coverage
2) Access to an adequate health care workforce for arthritis,
rheumatic and musculoskeletal diseases
3) Access to quality care for these diseases
4) Cost-effective care without reduction in quality health care
ACR paper online at www.rheumatology.org/advocacy.
Major Players
• Administration
– President Obama
– HHS
• Senators
– HELP Committee
• Kennedy
• Dodd
– Finance Committee
• Gang Of Six
• Representatives
– Waxman (D-CA)
– Rangel (D-NY)
– Miller (D-CA)
Senate Bills
Background
• Senate Health, Education, Labor & Pensions Committee
passed the “Affordable Health Choices Act” on July 15.
• Senate Finance Committee still negotiating bill. The Senate
Finance Committee is discussing the public insurance
option among other proposals.
• Senate will merge two committee bills and send to floor
for a vote.
Senate HELP Bill
Estimated cost: $597B
Coverage
• Includes an individual mandate on health insurance
• Prohibits excluding coverage based on pre-existing conditions
• Creates a public option (Community Health Insurance Option)
Provider participation is voluntary within the public plan option.
The Secretary can negotiate provider rates.
Senate HELP Bill
Other Provisions
• Follow-on biologics
• Loan repayment program for pediatric subspecialties
H.R. 3200 Tri-Committee Bill
Estimated cost: $1.042T
Background
• Passed by Education & Labor Committee on July 17.
• Passed by Ways & Means Committee on July 17.
• Passed by Energy & Commerce Committee on July 31.
Energy & Commerce has 55-60 additional amendments to
consider after August recess.
H.R. 3200
Tri-Committee Bill
Coverage
• Creates a Health Insurance Exchange where individuals and
employers can purchase health coverage
• Requires employers to provide coverage or pay into a Health
Insurance Exchange Trust Fund
• Prohibits excluding coverage based on pre-existing
conditions
H.R. 3200
Tri-Committee Bill
Provider Payment
• Eliminates 21.5% scheduled cut in Medicare Physician Fee Schedule
• Includes a 1% update
• Establishes two service categories which will receive individual
updates
•
E/M services in one category and volume growth is at a rate of GDP
+ 2%
• Removes Part B drugs from calculations
• Increases Medicaid payments to encourage provider participation
H.R. 3200
Tri-Committee Bill
Access to Drugs
• Allows the Secretary to negotiate drug prices
with pharmaceutical manufacturers
• Grants the Secretary authority to determine a
drug’s coverage in the public plan
H.R. 3200
Tri-Committee Bill
• Includes provisions on follow-on biologics
• Includes provisions relating to HIT
• Includes provisions relating to CER
• Removes prompt pay discounts of up to 2% from the ASP
calculation
H.R. 3200
Tri-Committee Bill
Imaging
• Calls for study on DXA utilization
H.R. 3200
Tri-Committee Bill
PQRI
• Requires Secretary to develop feedback mechanism (no
deadline specified) and appeals process for providers
participating in the PQRI program by January 1, 2011
Pending Amendment
Workforce
• Loan Repayment for Pediatric Subspecialties
What to Expect in September
•
Energy & Commerce will consider the remaining
amendments.
•
House will merge 3 committee passed bills and will
send to floor for a vote.
•
Senate Finance Committee has set a September 15
deadline to develop their bill.
•
Senate must merge two bills and send to floor.
•
Upon passing in both Chambers, Congress will go to
“conference” to negotiate final bill.
What Can You Do?
• Contact your Representative and Senators and
express your opinions on health care legislation.
– www.capwiz.com/acr
– AMA Grassroots Hotline: (800) 833-6354
• Visit your legislators at home: congressional recess
through September 7.
• Attend Annual Meeting Session with Rep. Allyson
Schwartz (D-PA) on Monday, October 19, 2:30-4:00,
to receive an update on health care reform.
What Can You Do?
Contribute to RheumPAC
Q:What is RheumPAC?
A: RheumPAC is a political action committee dedicated to
increasing the ACR’s presence on Capitol Hill.
A: RheumPAC supports the ACR in its efforts to build contacts,
influence and visibility within Washington, D.C.
A: RheumPAC increases the ACR’s access to members of Congress
and the opportunity to educate them on issues of importance to
rheumatology.
American College of Rheumatology
Questions?
ACR Government Affairs Department
Patton Boggs LLP