american college of rheumatology the current state of health care reform aiken hackett director,...
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American College of Rheumatology
The Current State of Health Care Reform
Aiken HackettDirector, Government Affairs
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Health Care Reform
Objectives
• 2010 Physician Fee Schedule
• Senate Health Care Reform
• House Health Care Reform
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Medicare Physician Fee Schedule
2010 Proposed Rule • Elimination of Consultation Codes
• Decrease of Infusion payments 25%
• Continuation of PQRI
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Medicare Physician Fee Schedule
2010 Proposed Rule What Is the ACR Doing?
• Submitting comments to CMS
• Working with other medical organizations and advocacy groups
• Submitted op-ed articles to major newspapers
• Encouraging members to submit comments to CMS and reach out to Congress
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Medicare Physician Fee Schedule
2010 Proposed Rule What Can You Do?
1. Submit letter to CMS by 5pm ET August 31Letter Template Online at www.rheumatology.org and
instructions on submission • Electronically at www.regulations.gov • USPS
Center of Medicare & Medicaid Services 400 Independence Ave, S.WWashington, D.C. 20201
2. Express your concerns with your members of Congress
Information can be found on the ACR Website atwww.rheumatology.org/advocacy under News Flash
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ACR Position on Health Care Reform
To ensure access to care, the ACR supports:
1) Access to affordable health coverage2) Access to an adequate health care workforce for
arthritis, rheumatic and musculoskeletal diseases3) Access to quality care for these diseases4) Cost-effective care without reduction in quality
health care
ACR paper online at www.rheumatology.org/advocacy.
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Major Players• Administration
– President Obama– HHS
• Senators– HELP Committee
• Kennedy• Dodd
– Finance Committee• Gang Of Six
• Representatives– Waxman (D-CA)– Rangel (D-NY)– Miller (D-CA)
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Senate Bills
Background
• Senate Health, Education, Labor & Pensions Committee passed the “Affordable Health Choices Act” on July 15.
• Senate Finance Committee still negotiating bill. The Senate Finance Committee is discussing the public insurance option among other proposals.
• Senate will merge two committee bills and send to floor for a vote.
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Senate HELP BillEstimated cost: $597B
Coverage
• Includes an individual mandate on health insurance
• Prohibits excluding coverage based on pre-existing conditions
• Creates a public option (Community Health Insurance Option)
Provider participation is voluntary within the public plan option.
The Secretary can negotiate provider rates.
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Senate HELP Bill
Other Provisions
• Follow-on biologics
• Loan repayment program for pediatric sub-specialties
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H.R. 3200 Tri-Committee Bill
Estimated cost: $1.042TBackground
• Passed by Education & Labor Committee on July 17.
• Passed by Ways & Means Committee on July 17.
• Passed by Energy & Commerce Committee on July 31.
Energy & Commerce has 55-60 additional amendments to consider after August recess.
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H.R. 3200Tri-Committee Bill
Coverage • Creates a Health Insurance Exchange where
individuals and employers can purchase health coverage
• Requires employers to provide coverage or pay into a Health Insurance Exchange Trust Fund
• Prohibits excluding coverage based on pre-existing conditions
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H.R. 3200Tri-Committee Bill
Provider Payment • Eliminates 21.5% scheduled cut in Medicare Physician Fee
Schedule
• Includes a 1% update
• Establishes two service categories which will receive individual updates
• E/M services in one category and volume growth is at a rate of GDP + 2%
• Removes Part B drugs from calculations
• Increases Medicaid payments to encourage provider participation
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H.R. 3200Tri-Committee Bill
Access to Drugs
• Allows the Secretary to negotiate drug prices with pharmaceutical manufacturers
• Grants the Secretary authority to
determine a drug’s coverage in the public plan
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H.R. 3200Tri-Committee Bill
• Includes provisions on follow-on biologics
• Includes provisions relating to HIT
• Includes provisions relating to CER
• Removes prompt pay discounts of up to 2% from the ASP calculation
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H.R. 3200 Tri-Committee Bill
Imaging
• Calls for study on DXA utilization
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H.R. 3200 Tri-Committee Bill
PQRI
• Requires Secretary to develop feedback mechanism (no deadline specified) and appeals process for providers participating in the PQRI program by January 1, 2011
Pending AmendmentWorkforce
• Loan Repayment for Pediatric Subspecialties
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What to Expect in September
• Energy & Commerce will consider the remaining amendments.
• House will merge 3 committee passed bills and will send to floor for a vote.
• Senate Finance Committee has set a September 15 deadline to develop their bill.
• Senate must merge two bills and send to floor.
• Upon passing in both Chambers, Congress will go to “conference” to negotiate final bill.
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What Can You Do? • Contact your Representative and Senators and
express your opinions on health care legislation. – www.capwiz.com/acr – AMA Grassroots Hotline: (800) 833-6354
• Visit your legislators at home: congressional recess through September 7.
• Attend Annual Meeting Session with Rep. Allyson Schwartz (D-PA) on Monday, October 19, 2:30-4:00, to receive an update on health care reform.
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What Can You Do? Contribute to RheumPAC
Q:What is RheumPAC? A: RheumPAC is a political action committee dedicated to
increasing the ACR’s presence on Capitol Hill.
A: RheumPAC supports the ACR in its efforts to build contacts, influence and visibility within Washington, D.C.
A: RheumPAC increases the ACR’s access to members of Congress and the opportunity to educate them on issues of importance to rheumatology.
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American College of Rheumatology
Questions?
ACR Government Affairs Department Patton Boggs LLP