Private contracting
Private contracting is permitted under current law, but physicians who engage in it must opt out of Medicare for 2 years; patients who sign a private contract must pay out of pocket, even for services covered by Medicare. Under S. 236/H.R. 1310 – the Medicare Patient Empowerment Act – the 2-year opt-out requirement would be eliminated and beneficiaries could use their benefits to offset a portion of the fee set by their physician. This would protect low-income patients, "dual-eligibles," and patients with certain emergent or urgent health conditions. It is opposed by the Democratic Party and AARP, who see it as a cost-shifting mechanism; others feel it is a way to help reduce Medicare spending, he noted.
Medical liability reform
There’s been "a lot of noise but not much action" when it comes to medical liability reform, Dr. Schweitz said.
A House bill that would have included a $250,000 cap on noneconomic damages was paired with the IPAB repeal bill in the 112th Congress but did not make it to the Senate.
"There’s no such bill active in this [113th] Congress, but there are other kinds of liability reform acts that are more focused," he said.
These include H.R. 36/S. 961, the Health Care Safety Net Enhancement Act of 2013, which would extend Federal Tort Claims Act liability protections to on-call specialty physicians; H.R. 1733, the Good Samaritan Health Professionals Act of 2013, which would limit liability of health care professionals who volunteer to provide health care in response to a declared natural disaster; and H.R. 1473, the Standard of Care Protection Act, which would protect physicians from the use of quality measures for reimbursement issues in other federal health care laws to be used as standards of care in liability lawsuits.
Biosimilars
The president’s 2014 budget proposes to reduce the exclusivity for brand names from 12 years to 7 years beginning in 2014 and to prohibit "evergreening" – the securing of additional periods of exclusivity for brand biologics because of minor changes in product formulations.
Additionally, the Coalition of State Rheumatology Organizations is lobbying state legislatures to ensure that biosimilars legislation includes appropriate patient protections, such as physician notification of any substitution, appropriate record keeping, and "dispense as written" requirements. To date, five such bills have passed, with North Dakota, Utah, Virginia, and Oregon including all of these measures and Florida including all but notification.
Graduate medical education
Workforce shortages aren’t just a primary care issue. They also affect multiple specialties, including rheumatology. Though not unique in this regard, rheumatology is representative of an aging specialty, with more physicians reaching the end of their careers than young physicians entering the field. Coupled with the aging population, this raises concerns. The coalition and the Alliance of Specialty Medicine Policy Roundtable on Workforce sought cosponsors for H.R. 1180 and S. 577, the Resident Physician Shortage Reduction Act of 2013, and H.R. 1201, the Training Tomorrow’s Doctor Today Act. These legislative initiatives seek to address the problem of residency-slot shortages.
Dr. Schweitz reported having no disclosures.