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Update: Congressional Action on Quality Improvement, Medicare, Value-Based Purchasing
The American College of Surgeons has been working for many years to improve the quality of care patients receive and to address and find possible solutions to the current 0problems with the Medicare physician payment formula. During the past year, discussions at the Centers for Medicare and Medicaid Services (CMS), at the Medicare Payment Advisory Commission (MedPAC), and within Congress have increasingly focused on how to provide payment incentives under the Medicare program to improve the overall quality of care for Medicare beneficiaries.
Legislation addressing these issues is currently before Congress. H.R. 3617, the "Medicare Value-Based Purchasing for Physicians' Services Act of 2005," would:
- Repeal the Sustainable Growth Rate methodology currently used to determine the annual update for Medicare physician payments and base future payments on the Medicare Economic Index, which measures annual practice inflation costs for physicians.
- Enact a phased-in, value-based purchasing program over several years by starting with voluntary, initial reporting measures beginning in 2007.
- Base quality measures for a value-based purchasing program on the efforts of physician specialty organizations, such as the College's work with the Surgical Care Improvement Project and the National Surgical Quality Improvement Program.
Surgeons are urged to contact their Congressional representatives to support H.R. 3617, and may do so electronically through the College's Legislative Action Center.
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Grassroots Advocacy Goes on the Road to NCSL
In August, the College's State Affairs Staff took their advocacy efforts "on the road" by co-hosting a booth at the National Conference of State Legislatures (NCSL) Annual Meeting in Seattle, WA. One of the largest of its kind, NSCL's annual meeting boasts a registration of over 5,000 attendees made up of state elected officials, their staffs, and representatives from various governmental, business, and not-for-profit organizations. Conference participants attend the meeting to exchange ideas and learn about various state issues. For the second year in a row, ACS partnered with a dozen other medical societies under the umbrella of "Physicians Advocating for Patients" to host the largest booth in the conference's exhibit hall. Many state officials and their staff members stopped and talked with the College's State Affairs staff about medical liability reform issues, office-based surgery regulations, provider taxes, and a host of other state-based topics.
Physicians Advocating for Patients
- American Academy of Ophthalmology
- American College of Cardiology
- American Medical Association
- American Academy of Otolaryngology
- American Osteopathic Association
- American Academy of Family Physicians
- American Academy of Pediatrics
- American Society of Anesthesiologists
- American College of Surgeons
- American College of Obstetricians and Gynecologists
- American Society of Plastic Surgeons
- Washington State Medical Society
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llinois Governor Signs Medical Liability Reform Legislation
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Gov. Blagojevich (D)
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Thanks to the efforts of many individuals and organizations, SB 475 passed earlier this year in a Democratic-controlled state that President Bush has referred to as a "judicial hellhole." The Illinois medical community can breathe a sigh of relief because on August 24, Gov. Rod Blagojevich signed the bill into law. The legislation contains much anticipated (and needed) medical liability reforms, such as: a firm $500,000 cap on noneconomic damages for physicians (and a $1 million cap for hospitals); an "I'm Sorry" provision; expansion of the Good Samaritan law to include retired physicians providing free care and for free care provided in the home; stronger standards for expert witnesses; and improvements to the affidavit of merit.
Compromises from both the opponents and proponents of SB 475 resulted in, among other things: enhanced medical disciplinary standards for physicians; internet profiling of physician's professional credentials, disciplinary and medical litigation histories; and additional regulation of the Illinois insurance industry.
For the full text of SB 475 click here.
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New York and California's Governors Veto UPPL
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Gov. George Pataki (R) |
Both New York's Gov. George Pataki (R) and California's Gov. Arnold Schwarzenegger (R) vetoed legislation that would make it illegal for insurance companies to deny payment of medical claims when an accident is a result of alcohol or illegal drug use.
In his veto message, Governor Pataki stated his opposition to the bill was "due to questions about the magnitude of the problem, concerns about broad scope of the proposed solution... and the need for comprehensive No-Fault auto insurance reform." Governor Schwarzenegger stated in his veto message that "Coverage for services for injuries due to alcohol and drug use should be available, but not mandated."
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Gov. Arnold
Schwarzenegger (R) |
Bills of this type had already been passed in 2001 in New York and 2004 in California, only to be vetoed. It was hoped that the bills introduced in 2005 had adequately addressed the objections of the Governors.
The American College of Surgeons worked with the surgeons of New York and California and the state chapters of ACS to educate the legislative leadership on this important issue during the 2005 legislative sessions and will continue to do so.
To read the full text of Governor Schwarzenegger's veto message: http://www.leginfo.ca.gov/pub/bill/sen/sb_0551-0600/sb_573_vt_20050711.html
For more information about these bills, please contact Mindy Baker, State Affairs Associate, at mbaker@facs.org.
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Michigan's Governor Proposes a 2.28% Tax on All Physician Services
Michigan Gov. Jennifer Granholm (D) has proposed a 2.28% gross receipts tax on all physicians in Michigan in order to increased funding for the state's Medicaid program. Although current versions of both the House and Senate budgets do not include the tax, the Governor has indicated her willingness to push for a physician tax to be included in the final version. A budget must be passed before Michigan's next fiscal year begins on October 1.
Proponents of the tax believe that, for many physicians, the increase in Medicaid reimbursement will be greater than the amount paid out in taxes. The opposition, however, is not quite as trusting—Gregory Forzley, MD, a member of the Michigan State Medical Society's Board of Directors, was quoted in Practice Trends comparing this tax to the state's lottery system. "When they introduced the state lottery, it was going to benefit K-12 education programs and colleges in the state, but it appears they used the lottery money in place of other governmental funding. So when they come with a similar-sounding proposal in a system already fraught with cutbacks and under funding, most people say, 'I don't believe you when you say you are going to put safeguards in.'"
Why the Proposed Tax Is Unhealthy for Medicaid:
From Michigan's HOD resolution 97-05A, approved May 1st 2005
- Gross receipts, rather than income, would be taxed (i.e., practices with high overhead would be penalized disproportionately compared to those with low overhead)
- No guarantee that Medicaid payment rates might not drop in the future, particularly if the federal government ends its matching program
- Inadequate funding is only one of many problems (administrative complexities, delayed payment, complicated billing rules, e.g.) facing Michigan's Medicaid program
- Would limit access to health care by discouraging new physicians from setting up practice in Michigan
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- Generating $40 million for an $8 billion budget would be grossly insufficient, particularly with Medicaid enrollment up 27% over the last five years and climbing
- Risky to rely on HMOs to redistribute the proposed increases in physician fees for two-thirds of the Medicaid program
- Unfairly targets a particular professional class (setting a dangerous precedent); Medicaid is a society-wide issue that requires a society-wide solution
- Stopgap funding will not fix the Medicaid program either in the short or long run, and will not solve the systemic crisis within the state budget
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Past Issues of ACS Cross Country:
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ACS State Affairs
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Division of Advocacy and Health Policy
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Jon H. Sutton
Manager, State Affairs
Chicago Headquarters
312-202-5358
jsutton@facs.org |
Mindy Baker
State Affairs Associate
Chicago Headquarters
312-202-5363
mbaker@facs.org |
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Revised September 8, 2005
Advocacy and Health Policy
This page and all contents are Copyright © 2003-2005
by the American College of Surgeons, Chicago, IL 60611-3211
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