Health Reform Bill Raises Questions, Society Tells Senators
In a letter sent to US Sens. Arlen Specter and Robert J. Casey Jr. on Dec. 18, the Pennsylvania Medical Society highlighted shortcomings in the most recent Senate health system reform bill. (See the full letter under Related Content).
“We continue to have serious concerns about the lack of substantive medical liability reform, a permanent fix to the Medicare physician payment system, and protections for the patient-physician relationship,” wrote Society President James A. Goodyear, MD.
The letter listed a number of tenets of the bill—HR 3590, the “Patient Protection and Affordable Care Act”—with which the Society agrees, including:
- Expanding access to health insurance and offering more affordable health insurance options
- Reforming the health insurance market to provide additional consumer protections
- Reducing health system delivery costs and improve outcomes
- Training more primary care physicians and addressing other health care workforce shortages
- Promoting preventive health care
- Adopting uniform administrative processes such as claims processing
- Reducing overpayments to Medicare Advantage plans
The State Society’s leadership is using the organization’s
Eight Essential Principles of Health System Reform to analyze the constantly changing health system reform proposals that are being debated and amended by Congress.
Based on the essential principles, said Dr. Goodyear, the leadership has become increasingly concerned that the legislation lacks many of the critical elements necessary for successfully reforming America’s health care delivery system.
Medical liability reform—The bill is devoid of any real medical liability reform measures. Instead, it expresses a “Sense of the Senate,” encouraging states to develop and test alternatives to the current civil litigation system as a way of addressing the medical liability problem.
Medicare physician payment formula—A permanent repeal of the SGR formula is critical to the goal of ensuring security and access for seniors, and for development of new payment models and delivery reforms. HR 3590 would avoid a 21.2 percent cut but only for 2010.
Medicaid expansions—Medicaid would be expanded to cover all individuals up to 133 percent of the federal poverty level (FPL), which would increase the number of individuals covered under the program by more than 40 percent. The bill creates a huge new unfunded mandate on states and would do little to increase provider participation caused by inadequate provider reimbursement.
Physician-owned hospitals—This bill would eliminate the whole hospital exception to the Stark self-referral law, prohibiting physician-owned hospitals from growing, forcing abandonment of physician-owned facilities currently under construction, and deterring new physician-owned facilities.
Independent Medicare Advisory Board— The new Independent Medicare Advisory Board and the new Center for Medicare & Medicaid Innovation would have unprecedented authority to change the Medicare program largely unchecked by Congress or the courts.
Reductions on imaging services—The legislation continues to propose severe cuts for imaging services. This change will have a negative impact on physicians’ utilization of advanced diagnostic imaging procedures to treat their patients and will impede patients’ access to advanced medical care.
Provider enrollment fees—The Society strongly opposes the imposition of enrollment fees on physicians for participating in Medicare and Medicaid programs.
Physician Quality Reporting Initiative (PQRI)—The State Society advocates for incentives for reporting quality-based measures, but we oppose any payment reductions for failure to report successfully. The PQRI program has not been reliable enough to warrant mandatory participation.
Program integrity funding, reporting requirements, new penalties—There are a number of fraud and abuse provisions included in the legislation that would penalize all physicians to find a small number of individuals who are intent on defrauding Medicare and other programs.
Patient rights—The right of patients to privately contract with the physician of their choice is not addressed in the legislation. Patients should have the right to choose their doctor and enter into agreements for the fees for those services without penalty.
Last Updated: 12/22/2009