TORONTO — The massive health care reform overhaul passed by Congress this year is here to stay, but officials at the American College of Physicians are hoping that Congress will make some modifications to improve the law for physicians.
At the top of the organization's wish list are changes to the Independent Payment Advisory Board (IPAB) created by the law, making permanent the boost in primary care payment rates under Medicare and Medicaid, and eliminating newly created penalties for failing to report quality data to Medicare.
“Health care reform is an ongoing journey. It's not a destination,” Robert B. Doherty, the ACP's senior vice president for governmental affairs and public policy, said at the group's annual meeting in April.
The ACP's plan is to influence how the law is implemented by offering comments as federal regulations are written and as states do their part to roll out provisions in the law. States will have a major role in implementation, Mr. Doherty said, since they are responsible for setting up their own health insurance exchanges in 2014 and awarding competitive grants to fund primary care programs. And as with other large federal programs, it's likely that Congress will pass additional legislation to amend the law as implementation moves along, he said.
The ACP's issue with the IPAB is that it vests too much power in an unelected body. The 15-member board, created by the Affordable Care Act, is charged with presenting proposals to Congress that would slow the growth of Medicare and private health care spending and improve the quality of care. The recommendations of the IPAB would take effect unless Congress votes to reject the proposals and in favor of its own plan for achieving the same level of savings. The IPAB is expected to submit its first recommendation to Congress in 2015.
The ACP also hopes that Congress will act to make permanent the temporary increases in primary care payments enacted under the law. For example, the health care reform law provides a 10% bonus payment to primary care physicians whose Medicare charges for office, nursing home, and home visits make up at least 60% of their total Medicare charges. Those payments will be available for 5 years, starting in 2011. The law also increases Medicaid payments up to the level of Medicare payments for primary care physicians delivering primary care services in 2013 and 2014.
Mr. Doherty said that although the law's payment provisions are time limited, he thinks it will be difficult for Congress to take this benefit away once it is in effect. ACP officials also plan to lobby Congress to expand the eligibility for these increased payments so that more primary care physicians can qualify.
The new law also extends the Medicare Physician Quality Reporting Initiative, which offers incentive payments for successful reporting of quality measures. Under the law, physicians can receive 1% bonus payments on Medicare charges in 2011 and 0.5% bonuses in 2012–2014. Starting in 2015, however, physicians who fail to report quality measures will receive a 1.5% cut in their Medicare reimbursement. That penalty will rise to 2% in 2016. Mr. Doherty said the ACP is seeking to eliminate the penalties outlined in the law.
One provision missing from the final health care reform package was a permanent fix to the Medicare physician payment formula, or sustainable growth rate (SGR). At the time, it wasn't politically feasible to get an SGR fix included in the reform legislation. However, Mr. Doherty said he expects that there will be a vote in the Senate on permanent repeal of the SGR this spring.
The challenge, he said, will be to round up 60 votes in the Senate, where fiscal conservatives want to see a method to pay for the $200 billion price tag of an SGR fix. Mr. Doherty argues that the SGR fix would not be a “real cost,” because it assumes that Congress would otherwise let the cuts happen each year.
In the meantime, the ACP, the American Medical Association, and other physician organizations have stopped helping lawmakers round up the votes needed for short-term fixes, instead opting to lobby only in favor of a permanent fix to the formula. “The only acceptable option is total repeal,” Mr. Doherty said.
The ACP also is launching a “nuts and bolts” educational campaign to help physicians and their patients better understand how the law will actually work. The campaign will include practical information on issues such as the Medicare doughnut hole.
'Health care reform is an ongoing journey. It's not a destination.'