Health Care Reform

On Saturday, November 21st by a vote of 60-39, the U.S. Senate agreed to move forward with debate and the offering of amendments on its health care reform legislation entitled, “The Patient Protection and Affordable Care Act,” starting the Monday after Thanksgiving with Senator Reid offering the first amendment and Senator McConnell offering the second amendment. Senate leadership anticipates the offering of amendments and debate to last at least the entire month of December and possibly into the New Year.

The Patient Protection and Affordable Care Act is comprised of nine sections, addressing the following areas:

• Quality, affordable health care for all Americans
• The role of public programs
• Improving the quality and efficiency of health care
• Prevention of chronic disease and improving public health
• Health care workforce
• Transparency and program integrity
• Improving access to innovative medical therapies
• Community living assistance services and supports
• Revenue provisions/pay fors.

To read a summary of this legislation, a section by section description of this 2074 page bill, and a comparison of all the various pieces of health care reform legislation, please visit the AUGS website at www.augs.org.

Of direct interest are the specific provisions that would impact AUGS members and their ability to provide quality care to women with pelvic floor and other lower urinary tract disorders. Below is a bulleted list of the provisions that may be of concerns to AUGS members and that are included in the Patient Protection and Affordable Care Act:

• Temporary one-year SGR “patch” to replace the 21.2 percent payment cut in 2010 with a 0.5 percent payment increase;
• Physician Quality Report Initiative (PQRI) would continue with bonus payments through FY 2014 (1% in 2010 and .5% for the remainder); however the program would become mandatory in 2015, with penalties of -1.5%, and -2% in 2016. The bill language also sets forth the possibility of Maintenance of Certification begin a way to qualify as having participated;
• Implementation of a new “value” index to adjust payments based on value, defined as quality over cost, in the budget neutral manner in CY 2015, with rulemaking starting in 2013 on defining the elements of the index;
• A 10 percent bonus to primary care specialties when providing primary care services starting in 2011, the concern is that 50% of bonus would be paid for by reductions in payments to all other providers for all other procedures. Reduction assumed to be .54% on all other services for each year for five years;
• A new Independent Medicare Advisory Board, that could make significant changes to the Medicare program, with little Congressional intervention when the growth in per beneficiary costs exceed 1.5 percent in a given year, beginning in 2014; and
• No meaningful medical liability reforms.

Many of these provisions are not included or are included in modified versions that are not as problematic, such as primary receives bonus payments, but not at the expenses of specialty care, in the House passed H.R. 3692, Affordable Health Care for America Act.

AUGS would also like to report two improvements in the Senate introduced legislation versus the health care reform legislation passed by the Finance Committee earlier this fall. Specifically, the elimination of a 5 percent payment cut for physicians’ whose resource use is found to be in the top 10 percent, changing the mandatory date of PQRI reporting from 2012, to 2015 and reducing the Medicare/Medicaid enrollment fee for physicians.

Finally, the Patient Protection and Affordable Care Act does contain many new programs and resources for prevention of disease, physician workforce, and expanded options for health insurance coverage for 94% of all Americans.

ACO Resource Center

The Patient Protection and Affordable Care Act