Senate Passes Health System Reform Bill

On December 24, the US Senate passed historic health system reform legislation in a 60-39 party line vote. Following is an overview of how the Senate bill compares with the ACCP Principles for Health System Reform.

ACCP Principle 1: Provide all Americans with access to affordable and portable health insurance that does not exclude or discriminate against those with preexisting conditions.

The legislation would provide more than 30 million more citizens with health-care coverage and removes many of the objectionable practices of the health insurance industry, such as discriminating against those with preexisting conditions. Health insurers could not impose lifetime limits on the total amount of services covered, could rescind coverage only for certain reasons, would have to cover certain preventive services with no cost sharing, and would have to allow unmarried dependents to be covered under their parents' policies up to age 26.

ACCP Principle 2: Increase the effectiveness of critical care physicians by providing incentives for telemedicine use in both rural and underserved inpatient critical care settings.

The legislation expects the Centers for Medicare and Medicaid Services (CMS) Innovation Center to test projects in inpatient settings (including ICUs) that facilitate the treatment of Medicare beneficiaries in their local hospitals through consultation and coordination with specialists at integrated health systems. These care coordination models would allow rural Medicare beneficiaries to receive acute inpatient services, including intensive care, at their local hospital with consultation from integrated health systems.

The criteria for care coordination models to be tested by the CMS Innovation Center would be expanded to facilitate inpatient care, including intensive care, of hospitalized Medicare beneficiaries at their local hospital. This would be done through the use of electronic monitoring by specialists, including intensivists and critical care specialists, based at integrated health systems.

ACCP Principle 3: Fund innovative, patient-centered approaches to critical care that support end-of-life counseling for critically ill patients and their families.

The legislation does not address this issue specifically. The ACCP will continue to advocate for this issue in the weeks and months ahead.

ACCP Principle 4: End the annual cycle of Medicare physician payment cuts.

The legislation does not address the flawed sustainable growth rate (SGR) formula, a critical component of health system reform. The ACCP will continue to advocate for this issue in the weeks and months ahead.

ACCP Principle 5: Implement strong and effective medical liability reforms to reduce the costs of defensive medicine and medical liability insurance.

The legislation includes $50 million to be spent over the next 5 years on demonstration projects on liability reform.

ACCP Principle 6: Health system reform should include national standardization of insurance credentialing, quality reporting, patient eligibility verification, claims submissions, and other reforms that will simplify and reduce administrative costs.

The legislation would implement administrative simplifications, as well as reporting requirements and incentive payments related to the physician quality reporting initiative (PQRI), including electronic prescribing and electronic health records.

While the Senate vote closes one chapter of the legislative process, the hard work continues. The ACCP will remain engaged throughout the conference process to improve the final bill and ensure the best outcome for our members and their patients.

Medicare Physician Payment Cuts Delayed

President Obama delayed the scheduled 21% cut for physician Medicare reimbursement until February 28, 2010, by signing into law HR 3326, the Department of Defense Appropriations Act, 2010. The legislation includes a short-term freeze of the SGR, in addition to providing for FY 2010 appropriations for the Department of Defense.

This short-term fix gives the Senate time to act on longer-term Medicare physician payment reform in either the health reform legislation through conference committee action or a free-standing bill similar to the one that the House passed last month. That bill, sponsored by Representative John Dingell (D-MI), passed by a vote of 243 to183 on November 19.

Within the next 60 days, Congress must address Medicare's fatally flawed SGR formula in order to achieve the access goals envisioned by health system reform legislation. The House, Senate, and the Obama administration have all committed to clear a pathway for passage of a permanent repeal of the SGR early next year. We must hold them to that timeline.