WASHINGTON WIRE
June 18, 2009
Issue 205
House Tri-Committee Democratic Bill on Health Reform Released
HELP Committee Begins Mark Up of Healthcare Reform Legislation; Finance Still Negotiating
AMA Adopts Recommendations to Protect Against Harm from Medicare Reforms
Former Senators Promote Healthcare Reform Proposal
House Subcommittee Holds Hearing on FDA Oversight of Medical Devices
MedPAC Releases Report Emphasizing Payment Reforms
PPSV Healthcare Practice Hosts Transplant Audio Conference
Hearings: Health Care Overhaul
Top Story
House Tri-Committee Democratic Bill on Health Reform Released
This Friday, House Democrats finally introduced a draft health reform bill. Their focus is creating "a level playing field" between a public option plan and private insurance options through a health insurance exchange projected to be completed by 2013. The exchange will include guaranteed issue, modified community rating, 2 to 1 age rating, and other provisions. It includes a payroll-based small business exemption. Pricing will be based at the local level, not national.
There is both an employer and individual mandate. The self-employed will be included with individuals. There is a five-year phase in for insurance companies with existing plans to implement the bill's changes. A new Benefits Commission will be created to define the contents of four benefit categories: Basic, Enhanced, Premium, Premium Plus. Insurers would have to offer a Basic package in addition to any others; they can only provide add-ons to the Premium Plus package. Medicaid would be expanded to cover everyone up to 133 percent of poverty and provide subsidies from 133 percent to 400 percent.
The bill also includes the previously announced permanent fix to CMS' sustainable growth rate (SGR) used to pay physicians. There will be a primary care "bucket" which will grow at 2 percent per year and a specialty bucket which will grow a 1-plus percent per year. Notably, the means to pay for the entire bill are still left undecided.
Health Care News
HELP Committee Begins Mark Up of Healthcare Reform Legislation; Finance Still Negotiating
The Senate Health, Education, and Pensions (HELP) Committee continues to mark up a draft healthcare reform bill, but the process is slowed by debate over amendments pertaining to key issues, such as comparative effectiveness research. In Chairman Edward Kennedy's (D-MA) absence, Senator Christopher Dodd has been chairing the mark up, which is likely to continue throughout the week of June 22. Democratic leaders hope to complete the mark up by the July 4 recess.
Meanwhile, the Senate Finance Committee leaders continue to aim for a bipartisan agreement on health care reform legislation. Senate Finance Committee Chairman Max Baucus (D-MT) originally expected to mark up the health care reform bill the week of June 22. But negotiations have slowed and it is possible the date could be pushed back until after the July 4 recess.
AMA Adopts Recommendations to Protect Against Harm from Medicare Reforms
On June 16, the American Medical Association's lobbying arm adopted recommendations that reforms to Medicare payment methodologies should not disadvantage or disenfranchise groups of physicians or patients. The recommendations are part of the group's Council on Medicare Service Report 6, which also suggests AMA push for adequate investment in comparative effectiveness research and in effective methods of translating research into clinical practice.
Former Senators Promote Healthcare Reform Proposal
On June 17, Former Senators Howard Baker (R-TN), Bob Dole (R-KS), and Tom Daschle (D-SD) released a bipartisan proposal to reform health care that proposes a budget-neutral plan. The proposal supports investment in health information technology, expansion of comparative effectiveness research and guaranteeing care for chronically ill beneficiaries. The plan also suggests a strategy guaranteeing access regardless of health status, partly through creating a network of state or regional-level health insurance exchanges. The question of whether to include a public option is left to the states.
House Subcommittee Holds Hearing on FDA Oversight of Medical Devices
On June 18, the House Energy and Commerce Subcommittee on Health held a hearing on FDA's oversight of medical devices. In January, the GAO released a report stating that FDA's pre-market approval process needed to be more stringent for certain devices, and in April the FDA started collecting more data from manufacturers. There are concerns that FDA might not have the resources to boost oversight. Industry advocates worry that beefing up oversight could slow advancements in medical technology to the detriment of business and patients.
MedPAC Releases Report Emphasizing Payment Reforms
On June 15, the Medicare Payment Advisory Commission (MedPAC) released their second annual report to Congress emphasizing the need for Congress to reform the Medicare payment system. The report does not make recommendations for Congress, but rather analyzes healthcare reform policies.
The MedPAC report focuses on changing Medicare payment incentives to reward quality rather than volume, and it also addresses the "silos" created by the current Medicare payment system. The report also suggests that Accountable Care Organizations (ACOs) could help control costs and improve quality. ACOs would incentivise coordination between primary care physicians, specialists and hospitals. If the ACO achieves quality and cost targets, members would receive a payment incentive.
The report also focused on reforming medical education to better align the curricula with the objectives of delivery system reform. According to the report, MedPAC could investigate links between medical education incentives and delivery system reforms.
PPSV in the News
PPSV Healthcare Practice Hosts Transplant Audio Conference
On June 11, over 100 transplant center personnel from around the country, participated in an audio-conference on transplant center issues put on by five of PPSV's senior reimbursement attorneys. The audio-conference covered three areas critical to transplant centers that participate in Medicare (1) organ acquisition costs; (2) cost report fraud and abuse issues; and (3) Medicare certification and appeals. Presentation materials are available on the PPSV website.
Upcoming Events
Hearings: Health Care Overhaul
Senate Health, Education, Labor and Pensions Committee
Full Committee Markup
June 19, 10:30 a.m., 325 Russell Bldg.; June 22, 3 p.m.; June 23, 10 a.m.; June 24, 10 a.m.; June 25, 10 a.m.; June 26, 10 a.m.
House Energy and Commerce Committee
Full Committee Hearing
June 24, 9:30 a.m., 2123 Rayburn Bldg.
House Energy and Commerce - Subcommittee on Health
June 23, 9:30 a.m., 2123 Rayburn Bldg.; June 24, Time TBA; June 25, 9:30 a.m.
House Education and Labor Committee
Full Committee Hearing
June 23, Noon, 2175 Rayburn Bldg.
House Ways and Means Committee
Full Committee Hearing
June 24, 10 a.m., 1100 Longworth Bldg.
Hearings: Other
Wednesday, June 24
Health IT Adoption and Small Practices
House Small Business - Subcommittee on Regulations and Healthcare
Subcommittee Hearing
10 a.m., 2360 Rayburn Bldg.
For More Information
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