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Health reform bill has AMA support – for now
January 11, 2010 e-Reports
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An open letter to physicians dated Dec. 23 detailed the AMA’s decision to support H.R. 3590, the health care bill passed by the U.S. Senate in the early hours of Christmas Eve. However, AMA leaders indicated some of the bill’s provisions are problematic. The AMA will continue working to correct them and to secure a permanent repeal of the sustainable growth rate (SGR) formula.

In December, the House and Senate passed a Department of Defense appropriations bill that included a halt to the planned 21 percent rate cut for Medicare physicians for 60 days, extending the 2009 conversion factor.

In its open letter, the AMA stated, “The pending health system reform legislation will achieve several of the essential elements for health system reform that we outlined last summer.”

Working around the clock, the AMA claimed victory in:

  • Blocking a proposed Medicare buy-in
  • Eliminating a proposed 5 percent cut in Medicare payments to physicians in the top 10th percentile of resource utilization
  • Stopping the proposed tax on elective cosmetic surgery and medical procedures
  • Eliminating a proposed Medicare/Medicaid enrollment fee for physicians
  • Modifying provisions establishing an independent comparative effectiveness research entity
  • Avoiding a budget neutrality adjustment for primary care and rural surgery bonuses so other physicians’ pay will not be cut to pay for them

“The Senate bill will improve choice and access to affordable health insurance coverage and eliminate denials based on pre-existing conditions,” said J. James Rohack, M.D., AMA president.

“It will increase coverage for preventive and wellness care that can lead to better disease prevention and management, and further the development of comparative effectiveness research that can help patients and physicians make informed treatment decisions.”

The measure now moves to a House-Senate conference committee to work out the differences between the House version of health care reform passed in November and the recently passed Senate version. The key difference is the provision for a government-operated health plan or “public option” in the House version, which is not in the Senate version. 

More work to be done

In addition to fixing the SGR formula, the AMA will work to maximize the opportunity for alternative medical liability reforms that protect effective state tort reform laws, like the one in Indiana. Other AMA concerns include the following.

  • Independent payment advisory board – This proposed board could impose spending targets that could result in more physician pay cuts. The AMA wants accountability, transparency and physician input for this board.
  • Cost/quality adjuster – The AMA seeks new payment methodologies based on accurate, valid and verifiable scientific data.
  • Medicare data release and quality improvement initiatives – The AMA wants any Medicare data released to be aggregated with private payment data for performance reports, and physicians to review and correct their data before public release.
  • Physician-owned hospitals – The AMA will advocate for modifying a final measure to protect existing physician-owned hospitals.

The AMA will be on the alert for any further problematic provisions to surface in conference committee, but the organization’s leaders believe we are closer than ever to realizing a number of AMA goals.

ISMA President Fred Ridge, M.D., said, “I am pleased that our leaders at the AMA continue to monitor and fight to improve the final health care reform bill. We all need to be vigilant to ensure that we get a bill that we can support.”

Dr. Ridge noted the House and the Senate bills – as they go to conference committee – meet some of the health care reform principles adopted last September by the ISMA House of Delegates in Resolution 09-67.

“I am, however, worried that SGR reform has been split from these bills and postponed until February, when congress can safely avoid fixing the flawed SGR formula if a health care reform bill has already been supported by organized medicine and signed into law. Also, neither of these bills will cover all uninsured Americans as we urge in our ISMA principles.”

See ISMA Resolution 09-67 here. Read AMA bulletins and grassroots alerts here.

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