Part II of a two-part series on this new legislation; see April 13, 2009, issue for Part I or visit here.

The American Recovery and Reinvestment Act of 2009 or ARRA has provisions that affect physicians, besides the incentives for health information technology implementation discussed in Part I last issue. Other provisions include changes regarding COBRA insurance, a withholding tax, wellness and prevention, training of future physicians and community health centers.

Indiana is expected to see about $6 billion in stimulus funds, and a good chunk of it – $1.5 billion – will be directed to Medicaid, as long as eligibility requirements remain the same.

The CER controversy
A provision concerning comparative effectiveness research (CER) has been discussed and debated in recent weeks. The AMA endorsed this concept because it promises to provide physicians with information about the effectiveness of different medical treatment options. Patients stand to benefit from any research that can demonstrate whether a particular treatment provides better outcomes, noted the AMA.

In an official statement, AMA President Nancy Nielsen, M.D., Ph.D., and President-elect J. James Rohack, M.D., said that research findings “…should be driven by clinical evidence and not be used solely to identify and promote the cheapest treatment option.”

See an AMA document discussing CER here.

The ARRA provides that the soon-to-be established Federal Coordinating Council for Comparative Effectiveness Research ensure its research does not include national clinical guidelines and will not mandate coverage determinations, reimbursement or other policies of public or private payers.

The Agency for Healthcare Research and Quality will receive $700 million to conduct CER, and the HHS secretary will submit an annual report on CER findings.

Subsidy for COBRA
Your patients who become unemployed will now have a better option for COBRA insurance. The ARRA sets up a 65 percent temporary (nine months) subsidy for COBRA premium for those involuntarily terminated between Sept. 1, 2008, and Dec. 31, 2009. There are gross income eligibility requirements.

In these changing and challenging times, physician practices should ask patients about changes in their employment and insurance at every visit. As an employer, you must notify staff you terminate about this new COBRA options; see the Department of Labor Web site here.

Other provisions
Additional provisions of interest to physicians appear here.

• A 3 percent withholding tax on government contractors, including Medicare providers, is now delayed from 2010 to 2011.
• Wellness and prevention programs will receive $1 billion in funding.
• Community health centers are targeted for $1.5 billion to be used for construction, equipment, health information technology and other services. (Indiana centers already awarded grant funds are in: Anderson, Clinton, East Chicago, Elkhart, Evansville, Fort Wayne, Gary, Indianapolis, Jeffersonville, Lafayette, Muncie, Portage, Trafalgar, Valparaiso and West Lafayette.)
• About $500 million will go to train primary health care providers and to help medical students with expense – if they agree to serve in an underserved community through the National Health Service Corps.
• The Indian Health Service will receive $415 million to modernize and improve care.
• The National Institute of Health will get $10 billion for new research grants, renovations and construction.

Are you an AMA member? If so, visit the AMA’s Organized Medical Staff Section Web site to join a discussion forum about the ARRA’s provisions (see Related Links).

Read an AMA rundown of ARRA provisions here.