In this session, Drs. Michelle Mourad and Christopher Moriates took a systematic approach to answer quality questions that we commonly encounter in our hospitalist practice. They reviewed current evidence including meta-analyses and systematic reviews to arrive at an answer for various quality-related questions. These are summarized below:
What are the common features of interventions that have successfully reduced re-admissions? Effective interventions that enhance patient capacity to reliably access and engage in post-discharge care has been associated with success in decreasing re-admissions.
Does patient engagement correlate with decreased resource use or readmissions? Patient activation is defined as knowledge, skills, confidence and inclination to assume responsibility for managing one’s own health. A higher patient activation score reduced the risk of 30-day hospital re-utilization.
Does patients’ report of their healthcare experience reflect quality of care? Patient satisfaction scores may be a reflection of their desires (for example, to get pain medications) regardless of clinical benefit. In these situations, quality should be based on achieving a mutual understanding of patient situation and treatment plan between the provider and patient.
Is there any relationship between quality of care and health outcomes? Positive associations were found between patient experience and safety/effectiveness. Including patient experience in quality improvement, therefore, may lead to improvements in safety and effectiveness. Reducing the trauma of hospitalization could improve patient satisfaction and outcomes. Efforts such as personalization, providing rest and nourishment, reducing stress disruption and surprises as well as providing a post discharge safety net are strategies to reduce the trauma of hospitalization, improve satisfaction and patient outcomes.
Is there anything we can do to make hand-offs safer? The I-PASS hand-off bundle for a systematic hand-off process was reviewed (Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver) as a means of reducing medical errors. When used in conjunction with training, faculty development and a culture-change campaign, this was associated with improving patient safety without negatively affecting workflow.
How can hospitalists deflate medical bills? Patient expectations of the benefits and harms of clinical interventions influences physician decision making and contributes to overuse and increased healthcare costs. Harm of excessive testing was underestimated in such situations. Conversations with patients, colleagues and the public are crucial to decreasing low value care. Physicians should discuss potential benefits and risks to address patient expectations. In addition, they should seek opportunities to better understand healthcare costs.
How big of a problem is antibiotic overuse in hospitals and can we do better? In a national database review, more than half of all patients (55.7%) discharged from a hospital received antibiotics during their stay. There is a wide variation in antibiotic use across hospital wards. Reducing this exposure to broad spectrum antibiotics would lead to a 26% reduction in C. diff infections and reduce antibiotic resistance. To improve this over-utilization, stewardship programs should actively engage and educate clinicians, encourage clear antibiotic documentation in daily progress notes and use 72-hour antibiotic time-out during multidisciplinary rounds. TH
In this session, Drs. Michelle Mourad and Christopher Moriates took a systematic approach to answer quality questions that we commonly encounter in our hospitalist practice. They reviewed current evidence including meta-analyses and systematic reviews to arrive at an answer for various quality-related questions. These are summarized below:
What are the common features of interventions that have successfully reduced re-admissions? Effective interventions that enhance patient capacity to reliably access and engage in post-discharge care has been associated with success in decreasing re-admissions.
Does patient engagement correlate with decreased resource use or readmissions? Patient activation is defined as knowledge, skills, confidence and inclination to assume responsibility for managing one’s own health. A higher patient activation score reduced the risk of 30-day hospital re-utilization.
Does patients’ report of their healthcare experience reflect quality of care? Patient satisfaction scores may be a reflection of their desires (for example, to get pain medications) regardless of clinical benefit. In these situations, quality should be based on achieving a mutual understanding of patient situation and treatment plan between the provider and patient.
Is there any relationship between quality of care and health outcomes? Positive associations were found between patient experience and safety/effectiveness. Including patient experience in quality improvement, therefore, may lead to improvements in safety and effectiveness. Reducing the trauma of hospitalization could improve patient satisfaction and outcomes. Efforts such as personalization, providing rest and nourishment, reducing stress disruption and surprises as well as providing a post discharge safety net are strategies to reduce the trauma of hospitalization, improve satisfaction and patient outcomes.
Is there anything we can do to make hand-offs safer? The I-PASS hand-off bundle for a systematic hand-off process was reviewed (Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver) as a means of reducing medical errors. When used in conjunction with training, faculty development and a culture-change campaign, this was associated with improving patient safety without negatively affecting workflow.
How can hospitalists deflate medical bills? Patient expectations of the benefits and harms of clinical interventions influences physician decision making and contributes to overuse and increased healthcare costs. Harm of excessive testing was underestimated in such situations. Conversations with patients, colleagues and the public are crucial to decreasing low value care. Physicians should discuss potential benefits and risks to address patient expectations. In addition, they should seek opportunities to better understand healthcare costs.
How big of a problem is antibiotic overuse in hospitals and can we do better? In a national database review, more than half of all patients (55.7%) discharged from a hospital received antibiotics during their stay. There is a wide variation in antibiotic use across hospital wards. Reducing this exposure to broad spectrum antibiotics would lead to a 26% reduction in C. diff infections and reduce antibiotic resistance. To improve this over-utilization, stewardship programs should actively engage and educate clinicians, encourage clear antibiotic documentation in daily progress notes and use 72-hour antibiotic time-out during multidisciplinary rounds. TH
In this session, Drs. Michelle Mourad and Christopher Moriates took a systematic approach to answer quality questions that we commonly encounter in our hospitalist practice. They reviewed current evidence including meta-analyses and systematic reviews to arrive at an answer for various quality-related questions. These are summarized below:
What are the common features of interventions that have successfully reduced re-admissions? Effective interventions that enhance patient capacity to reliably access and engage in post-discharge care has been associated with success in decreasing re-admissions.
Does patient engagement correlate with decreased resource use or readmissions? Patient activation is defined as knowledge, skills, confidence and inclination to assume responsibility for managing one’s own health. A higher patient activation score reduced the risk of 30-day hospital re-utilization.
Does patients’ report of their healthcare experience reflect quality of care? Patient satisfaction scores may be a reflection of their desires (for example, to get pain medications) regardless of clinical benefit. In these situations, quality should be based on achieving a mutual understanding of patient situation and treatment plan between the provider and patient.
Is there any relationship between quality of care and health outcomes? Positive associations were found between patient experience and safety/effectiveness. Including patient experience in quality improvement, therefore, may lead to improvements in safety and effectiveness. Reducing the trauma of hospitalization could improve patient satisfaction and outcomes. Efforts such as personalization, providing rest and nourishment, reducing stress disruption and surprises as well as providing a post discharge safety net are strategies to reduce the trauma of hospitalization, improve satisfaction and patient outcomes.
Is there anything we can do to make hand-offs safer? The I-PASS hand-off bundle for a systematic hand-off process was reviewed (Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver) as a means of reducing medical errors. When used in conjunction with training, faculty development and a culture-change campaign, this was associated with improving patient safety without negatively affecting workflow.
How can hospitalists deflate medical bills? Patient expectations of the benefits and harms of clinical interventions influences physician decision making and contributes to overuse and increased healthcare costs. Harm of excessive testing was underestimated in such situations. Conversations with patients, colleagues and the public are crucial to decreasing low value care. Physicians should discuss potential benefits and risks to address patient expectations. In addition, they should seek opportunities to better understand healthcare costs.
How big of a problem is antibiotic overuse in hospitals and can we do better? In a national database review, more than half of all patients (55.7%) discharged from a hospital received antibiotics during their stay. There is a wide variation in antibiotic use across hospital wards. Reducing this exposure to broad spectrum antibiotics would lead to a 26% reduction in C. diff infections and reduce antibiotic resistance. To improve this over-utilization, stewardship programs should actively engage and educate clinicians, encourage clear antibiotic documentation in daily progress notes and use 72-hour antibiotic time-out during multidisciplinary rounds. TH
Physicians cannot sue state governments over low Medicaid payments, the U.S. Supreme Court ruled.
In a 5-4 decision, the high court overturned a decision by the 9th Circuit Court of Appeals that said physicians and other providers could sue to hold states accountable to the equal access provisions of the Medicaid Act (states accepting federal Medicaid funding are required to set pay rates at levels sufficient to ensure access to care).
In the case, Armstrong v. Exceptional Child Centers Inc., justices were determining whether the Constitution’s Supremacy Clause – which establishes the Constitution and federal law as the law of the land – gives providers the right to sue. The case originates from a 2009 lawsuit by Exceptional Child Center Inc., of Twin Falls, Idaho, and four other residential habilitation centers against Richard Armstrong, director of the Idaho Department of Health and Welfare.
In the majority opinion, Justice Antonin Scalia noted that physicians who believe Medicaid rates are inadequate have an administrative remedy by petitioning the Centers for Medicare & Medicaid Services, a remedy that “shows that the Medicaid Act precludes private enforcement ... in the courts.” He added that the plaintiffs must first seek relief through CMS first before instigating legal action.
In the dissenting opinion, Justice Sonia Sotomayor noted that seeking administrative relief could lead to reduced federal funding to a state for violating the Medicaid Act’s rate requirements, adding that “HHS is often reluctant to initiate compliance actions because a ‘state’s noncompliance creates a damned-if-you-do, damned-if-you-don’t scenario where withholding of state funds will lead to depriving the poor of essential medical assistance.’ ”
Justice Scalia dismissed that logic. “The dissent’s complaint that the sanction available to the [HHS] Secretary (the cut-off of funding) is too massive to be a realistic source of relief seems to us mistaken. We doubt that the Secretary’s notice to a state that its compensation scheme is inadequate will be ignored.”
Physicians cannot sue state governments over low Medicaid payments, the U.S. Supreme Court ruled.
In a 5-4 decision, the high court overturned a decision by the 9th Circuit Court of Appeals that said physicians and other providers could sue to hold states accountable to the equal access provisions of the Medicaid Act (states accepting federal Medicaid funding are required to set pay rates at levels sufficient to ensure access to care).
In the case, Armstrong v. Exceptional Child Centers Inc., justices were determining whether the Constitution’s Supremacy Clause – which establishes the Constitution and federal law as the law of the land – gives providers the right to sue. The case originates from a 2009 lawsuit by Exceptional Child Center Inc., of Twin Falls, Idaho, and four other residential habilitation centers against Richard Armstrong, director of the Idaho Department of Health and Welfare.
In the majority opinion, Justice Antonin Scalia noted that physicians who believe Medicaid rates are inadequate have an administrative remedy by petitioning the Centers for Medicare & Medicaid Services, a remedy that “shows that the Medicaid Act precludes private enforcement ... in the courts.” He added that the plaintiffs must first seek relief through CMS first before instigating legal action.
In the dissenting opinion, Justice Sonia Sotomayor noted that seeking administrative relief could lead to reduced federal funding to a state for violating the Medicaid Act’s rate requirements, adding that “HHS is often reluctant to initiate compliance actions because a ‘state’s noncompliance creates a damned-if-you-do, damned-if-you-don’t scenario where withholding of state funds will lead to depriving the poor of essential medical assistance.’ ”
Justice Scalia dismissed that logic. “The dissent’s complaint that the sanction available to the [HHS] Secretary (the cut-off of funding) is too massive to be a realistic source of relief seems to us mistaken. We doubt that the Secretary’s notice to a state that its compensation scheme is inadequate will be ignored.”
Physicians cannot sue state governments over low Medicaid payments, the U.S. Supreme Court ruled.
In a 5-4 decision, the high court overturned a decision by the 9th Circuit Court of Appeals that said physicians and other providers could sue to hold states accountable to the equal access provisions of the Medicaid Act (states accepting federal Medicaid funding are required to set pay rates at levels sufficient to ensure access to care).
In the case, Armstrong v. Exceptional Child Centers Inc., justices were determining whether the Constitution’s Supremacy Clause – which establishes the Constitution and federal law as the law of the land – gives providers the right to sue. The case originates from a 2009 lawsuit by Exceptional Child Center Inc., of Twin Falls, Idaho, and four other residential habilitation centers against Richard Armstrong, director of the Idaho Department of Health and Welfare.
In the majority opinion, Justice Antonin Scalia noted that physicians who believe Medicaid rates are inadequate have an administrative remedy by petitioning the Centers for Medicare & Medicaid Services, a remedy that “shows that the Medicaid Act precludes private enforcement ... in the courts.” He added that the plaintiffs must first seek relief through CMS first before instigating legal action.
In the dissenting opinion, Justice Sonia Sotomayor noted that seeking administrative relief could lead to reduced federal funding to a state for violating the Medicaid Act’s rate requirements, adding that “HHS is often reluctant to initiate compliance actions because a ‘state’s noncompliance creates a damned-if-you-do, damned-if-you-don’t scenario where withholding of state funds will lead to depriving the poor of essential medical assistance.’ ”
Justice Scalia dismissed that logic. “The dissent’s complaint that the sanction available to the [HHS] Secretary (the cut-off of funding) is too massive to be a realistic source of relief seems to us mistaken. We doubt that the Secretary’s notice to a state that its compensation scheme is inadequate will be ignored.”
The Supreme Court has declined to hear a case challenging the Independent Payment Advisory Board.
This leaves in place a ruling from the 9th U.S. Circuit Court of appeals, which dismissed the lawsuit Coons v. Lew, on the grounds that the plaintiffs failed to show harm from the provision of the Affordable Care Act that created the IPAB.
The 15-member panel, created under the ACA to help control health care costs, is charged with identifying cuts to Medicare when the program’s spending exceeds gross domestic product plus 1%. Current slowing growth in Medicare spending had meant that the IPAB provision has not be triggered, and so far no members have been named to the panel.
Attorneys representing the plaintiff said they remain ready to refile their case if and when the IPAB is ever activated.
“This case is not dead; we’re simply in a holding pattern,” Christina Sandefur, senior attorney at the Goldwater Institute, said in a statement.
Congress also continues to look at the IPAB. In March, Rep. Phil Roe (R-Tenn.) reintroduced legislation to repeal the panel.
The Supreme Court has declined to hear a case challenging the Independent Payment Advisory Board.
This leaves in place a ruling from the 9th U.S. Circuit Court of appeals, which dismissed the lawsuit Coons v. Lew, on the grounds that the plaintiffs failed to show harm from the provision of the Affordable Care Act that created the IPAB.
The 15-member panel, created under the ACA to help control health care costs, is charged with identifying cuts to Medicare when the program’s spending exceeds gross domestic product plus 1%. Current slowing growth in Medicare spending had meant that the IPAB provision has not be triggered, and so far no members have been named to the panel.
Attorneys representing the plaintiff said they remain ready to refile their case if and when the IPAB is ever activated.
“This case is not dead; we’re simply in a holding pattern,” Christina Sandefur, senior attorney at the Goldwater Institute, said in a statement.
Congress also continues to look at the IPAB. In March, Rep. Phil Roe (R-Tenn.) reintroduced legislation to repeal the panel.
The Supreme Court has declined to hear a case challenging the Independent Payment Advisory Board.
This leaves in place a ruling from the 9th U.S. Circuit Court of appeals, which dismissed the lawsuit Coons v. Lew, on the grounds that the plaintiffs failed to show harm from the provision of the Affordable Care Act that created the IPAB.
The 15-member panel, created under the ACA to help control health care costs, is charged with identifying cuts to Medicare when the program’s spending exceeds gross domestic product plus 1%. Current slowing growth in Medicare spending had meant that the IPAB provision has not be triggered, and so far no members have been named to the panel.
Attorneys representing the plaintiff said they remain ready to refile their case if and when the IPAB is ever activated.
“This case is not dead; we’re simply in a holding pattern,” Christina Sandefur, senior attorney at the Goldwater Institute, said in a statement.
Congress also continues to look at the IPAB. In March, Rep. Phil Roe (R-Tenn.) reintroduced legislation to repeal the panel.
The Affordable Care Act’s requirement that health insurers pay out a minimum percentage of premiums in medical claims or quality improvement generated $5 billion in savings from 2011 to 2013, according to the Commonwealth Fund.
However, insurance companies were not increasing spending on quality improvements during that period, according to a report released March 26.
Under the ACA, insurers who fail to meet minimum percentages of premiums paid as claims must rebate the difference to consumers.
thinkstockphotos.com
In 2011, insurers paid $1.1 billion in rebates, researchers found. That figured dropped to $325 million in 2013, with the rebate total across the 3-year period being nearly $2 billion. The remaining $3 billion was generated from reductions in administrative costs without any increase in net profits during that time period.
The decline in consumer rebates reflects “greater compliance with the [medical loss ratio] rule,” the report’s authors noted, and “that insurers are spending a larger percentage of premium dollars on medical claims.”
The report noted that insurers could spend premium dollars on quality improvement to meet requirements – but in 2013, those quality improvement expenses remained at just below 1% and were relatively steady during the study period.
The Affordable Care Act’s requirement that health insurers pay out a minimum percentage of premiums in medical claims or quality improvement generated $5 billion in savings from 2011 to 2013, according to the Commonwealth Fund.
However, insurance companies were not increasing spending on quality improvements during that period, according to a report released March 26.
Under the ACA, insurers who fail to meet minimum percentages of premiums paid as claims must rebate the difference to consumers.
thinkstockphotos.com
In 2011, insurers paid $1.1 billion in rebates, researchers found. That figured dropped to $325 million in 2013, with the rebate total across the 3-year period being nearly $2 billion. The remaining $3 billion was generated from reductions in administrative costs without any increase in net profits during that time period.
The decline in consumer rebates reflects “greater compliance with the [medical loss ratio] rule,” the report’s authors noted, and “that insurers are spending a larger percentage of premium dollars on medical claims.”
The report noted that insurers could spend premium dollars on quality improvement to meet requirements – but in 2013, those quality improvement expenses remained at just below 1% and were relatively steady during the study period.
The Affordable Care Act’s requirement that health insurers pay out a minimum percentage of premiums in medical claims or quality improvement generated $5 billion in savings from 2011 to 2013, according to the Commonwealth Fund.
However, insurance companies were not increasing spending on quality improvements during that period, according to a report released March 26.
Under the ACA, insurers who fail to meet minimum percentages of premiums paid as claims must rebate the difference to consumers.
thinkstockphotos.com
In 2011, insurers paid $1.1 billion in rebates, researchers found. That figured dropped to $325 million in 2013, with the rebate total across the 3-year period being nearly $2 billion. The remaining $3 billion was generated from reductions in administrative costs without any increase in net profits during that time period.
The decline in consumer rebates reflects “greater compliance with the [medical loss ratio] rule,” the report’s authors noted, and “that insurers are spending a larger percentage of premium dollars on medical claims.”
The report noted that insurers could spend premium dollars on quality improvement to meet requirements – but in 2013, those quality improvement expenses remained at just below 1% and were relatively steady during the study period.
The Senate adjourned for a 2-week recess early on March 27, leaving without taking action on House-passed legislation to repeal the Medicare Sustainable Growth Rate formula and reauthorize the Children’s Health Insurance Program.
The Senate will not convene again until April 13, nearly 2 weeks after a temporary SGR patch expires. Doctors will see their Medicare pay cut by 21% on April 1.
thinkstockphotos.com
As has happened in the SGR’s troubled past and for other reasons, doctors and legislators expect the Centers for Medicare & Medicaid Services to hold Medicare payments for a while until the Senate can act.
A 2-week hold generally does not impact physicians’ practices too harshly, Dr. Robert Wergin, president of the American Academy of Family Physicians, said regarding an administrative hold CMS announced in January 2015. “It does affect your cash flow, but it has happened in the past, particularly around the time with SGR patches.”
The American Medical Association called for the Senate to address H.R. 2 as soon as it returns.
“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Robert Wah, president of the AMA, said in a statement. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
The Senate adjourned for a 2-week recess early on March 27, leaving without taking action on House-passed legislation to repeal the Medicare Sustainable Growth Rate formula and reauthorize the Children’s Health Insurance Program.
The Senate will not convene again until April 13, nearly 2 weeks after a temporary SGR patch expires. Doctors will see their Medicare pay cut by 21% on April 1.
thinkstockphotos.com
As has happened in the SGR’s troubled past and for other reasons, doctors and legislators expect the Centers for Medicare & Medicaid Services to hold Medicare payments for a while until the Senate can act.
A 2-week hold generally does not impact physicians’ practices too harshly, Dr. Robert Wergin, president of the American Academy of Family Physicians, said regarding an administrative hold CMS announced in January 2015. “It does affect your cash flow, but it has happened in the past, particularly around the time with SGR patches.”
The American Medical Association called for the Senate to address H.R. 2 as soon as it returns.
“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Robert Wah, president of the AMA, said in a statement. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
The Senate adjourned for a 2-week recess early on March 27, leaving without taking action on House-passed legislation to repeal the Medicare Sustainable Growth Rate formula and reauthorize the Children’s Health Insurance Program.
The Senate will not convene again until April 13, nearly 2 weeks after a temporary SGR patch expires. Doctors will see their Medicare pay cut by 21% on April 1.
thinkstockphotos.com
As has happened in the SGR’s troubled past and for other reasons, doctors and legislators expect the Centers for Medicare & Medicaid Services to hold Medicare payments for a while until the Senate can act.
A 2-week hold generally does not impact physicians’ practices too harshly, Dr. Robert Wergin, president of the American Academy of Family Physicians, said regarding an administrative hold CMS announced in January 2015. “It does affect your cash flow, but it has happened in the past, particularly around the time with SGR patches.”
The American Medical Association called for the Senate to address H.R. 2 as soon as it returns.
“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Robert Wah, president of the AMA, said in a statement. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.
Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.
“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”
If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.
The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.
Rep. Michael C. Burgess
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers
During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.
“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”
Physician associations commended passage of the bill.
Dr. Robert M. Wah
“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.
Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.
“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”
By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.
Dr. Robert L. Wergin
“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”
Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.
“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.
President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.
Dr. Kim Allan Williams Sr.
“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.
The bill’s passage comes as the latest SGR patch is set to expire on March 31.
The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.
Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.
“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”
But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.
“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”
Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.
Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.
“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”
If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.
The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.
Rep. Michael C. Burgess
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers
During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.
“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”
Physician associations commended passage of the bill.
Dr. Robert M. Wah
“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.
Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.
“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”
By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.
Dr. Robert L. Wergin
“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”
Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.
“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.
President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.
Dr. Kim Allan Williams Sr.
“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.
The bill’s passage comes as the latest SGR patch is set to expire on March 31.
The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.
Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.
“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”
But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.
“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”
Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.
Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.
“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”
If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.
The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.
Rep. Michael C. Burgess
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers
During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.
“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”
Physician associations commended passage of the bill.
Dr. Robert M. Wah
“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.
Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.
“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”
By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.
Dr. Robert L. Wergin
“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”
Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.
“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.
President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.
Dr. Kim Allan Williams Sr.
“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.
The bill’s passage comes as the latest SGR patch is set to expire on March 31.
The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.
Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.
“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”
But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.
“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”
After years of failed attempts and temporary fixes, the House of Representatives on March 26 passed H.R. 2, a bill to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that temporarily would raise Medicare physician pay and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years, as well as other provisions.
Check back for detailed analysis and next steps for the legislation later on March 26.
After years of failed attempts and temporary fixes, the House of Representatives on March 26 passed H.R. 2, a bill to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that temporarily would raise Medicare physician pay and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years, as well as other provisions.
Check back for detailed analysis and next steps for the legislation later on March 26.
After years of failed attempts and temporary fixes, the House of Representatives on March 26 passed H.R. 2, a bill to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that temporarily would raise Medicare physician pay and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years, as well as other provisions.
Check back for detailed analysis and next steps for the legislation later on March 26.
The federal government has launched the Health Care Payment Learning and Action Network as a way to help physicians and other players in the health care system transition to value-based medical care. The network was announced March 25 at a White House event.
“Health reform is really hard,” President Obama said at the event. “Everyone in the trenches knows that.”
Courtesy whitehouse.gov
HHS Secretary Sylvia M. Burwell
In January, Sylvia M. Burwell, secretary of the Department of Health & Human Services, announced what the administration portrays as the next step in heath reform. Building on the cost-saving efforts of the health reform law’s accountable care organizations, HHS plans to shift at least a third of all Medicare payments away from fee-for-service to value-based payment models by 2016. By 2018, half of all Medicare payments are to be value based.
The Health Care Payment Learning and Action Network is intended to support those goals and give everyone a say in the process’s success, Secretary Burwell said at the briefing.
Specifically, the network will facilitate new care delivery models and the collection, analysis, and leverage of data from them; break down obstacles to care; create evidence-based quality metrics that do not create record-keeping burdens; and foster transparency in the health care system, according to the Centers for Medicare & Medicaid Services.
Over 2,800 partners have registered with the network, including physician organizations, insurers, accountable care organizations, hospitals and health systems, and patient advocacy groups, according to CMS.
At the briefing, Bruce Broussard, CEO of network partner Humana, said that the ACA’s focus on quality has “wrapped the focus around the journey of someone’s health. It’s really changing the system from a treatment-oriented one to a health-oriented one.”
Dr. Robert Wah, president of the American Medical Association, said that his organization joined the network because of the access to decision makers that participation is expected to give.
“It is critical that physicians take a proactive role in defining the details of new payment models, and this network will help facilitate that,” Dr. Wah said in an interview.
The federal government has launched the Health Care Payment Learning and Action Network as a way to help physicians and other players in the health care system transition to value-based medical care. The network was announced March 25 at a White House event.
“Health reform is really hard,” President Obama said at the event. “Everyone in the trenches knows that.”
Courtesy whitehouse.gov
HHS Secretary Sylvia M. Burwell
In January, Sylvia M. Burwell, secretary of the Department of Health & Human Services, announced what the administration portrays as the next step in heath reform. Building on the cost-saving efforts of the health reform law’s accountable care organizations, HHS plans to shift at least a third of all Medicare payments away from fee-for-service to value-based payment models by 2016. By 2018, half of all Medicare payments are to be value based.
The Health Care Payment Learning and Action Network is intended to support those goals and give everyone a say in the process’s success, Secretary Burwell said at the briefing.
Specifically, the network will facilitate new care delivery models and the collection, analysis, and leverage of data from them; break down obstacles to care; create evidence-based quality metrics that do not create record-keeping burdens; and foster transparency in the health care system, according to the Centers for Medicare & Medicaid Services.
Over 2,800 partners have registered with the network, including physician organizations, insurers, accountable care organizations, hospitals and health systems, and patient advocacy groups, according to CMS.
At the briefing, Bruce Broussard, CEO of network partner Humana, said that the ACA’s focus on quality has “wrapped the focus around the journey of someone’s health. It’s really changing the system from a treatment-oriented one to a health-oriented one.”
Dr. Robert Wah, president of the American Medical Association, said that his organization joined the network because of the access to decision makers that participation is expected to give.
“It is critical that physicians take a proactive role in defining the details of new payment models, and this network will help facilitate that,” Dr. Wah said in an interview.
The federal government has launched the Health Care Payment Learning and Action Network as a way to help physicians and other players in the health care system transition to value-based medical care. The network was announced March 25 at a White House event.
“Health reform is really hard,” President Obama said at the event. “Everyone in the trenches knows that.”
Courtesy whitehouse.gov
HHS Secretary Sylvia M. Burwell
In January, Sylvia M. Burwell, secretary of the Department of Health & Human Services, announced what the administration portrays as the next step in heath reform. Building on the cost-saving efforts of the health reform law’s accountable care organizations, HHS plans to shift at least a third of all Medicare payments away from fee-for-service to value-based payment models by 2016. By 2018, half of all Medicare payments are to be value based.
The Health Care Payment Learning and Action Network is intended to support those goals and give everyone a say in the process’s success, Secretary Burwell said at the briefing.
Specifically, the network will facilitate new care delivery models and the collection, analysis, and leverage of data from them; break down obstacles to care; create evidence-based quality metrics that do not create record-keeping burdens; and foster transparency in the health care system, according to the Centers for Medicare & Medicaid Services.
Over 2,800 partners have registered with the network, including physician organizations, insurers, accountable care organizations, hospitals and health systems, and patient advocacy groups, according to CMS.
At the briefing, Bruce Broussard, CEO of network partner Humana, said that the ACA’s focus on quality has “wrapped the focus around the journey of someone’s health. It’s really changing the system from a treatment-oriented one to a health-oriented one.”
Dr. Robert Wah, president of the American Medical Association, said that his organization joined the network because of the access to decision makers that participation is expected to give.
“It is critical that physicians take a proactive role in defining the details of new payment models, and this network will help facilitate that,” Dr. Wah said in an interview.
While legislation expanding how and where Texans can carry weapons is dominating the state legislature this week, one state lawmaker is targeting the doctor’s office as a place to keep the federal government from learning who owns guns.
Over the objections of the medical community, state Rep. Stuart Spitzer, R-Kaufman, has filed a bill that would prohibit doctors from asking patients whether they own a firearm and makes the Texas Medical Board, which licenses physicians, responsible for doling out punishment.
“Pediatricians are asking children away from their parents, ‘Do you have guns in your house?’ and then reporting this on the electronic health records, and then the federal government, frankly, has access to who has guns and who doesn’t,” Rep. Spitzer said in a recent interview. He said he experienced the phenomenon firsthand when he took his daughter to the doctor, who asked her whether there were any guns in the house.
Rep. Spitzer, a surgeon, said he wanted to make sure that doctors “have the right not to ask that.”
But doctors’ groups say House Bill 2823 would squelch important discussions that are part of the physician-patient relationship.
“We, as physicians, ask all sorts of questions – about bike helmets and seat belts and swimming pool hazards, dangerous chemicals in the home, sexual behaviors, domestic violence. I could go on and on,” said Gary Floyd, a Fort Worth pediatrician and board member of the Texas Medical Association.
“All of that’s geared mainly to how we should direct our advice,” he said. “As a pediatric [emergency room] doc, one of the worst things you have to do is sit down with the family and explain that the child has died, or may never be the same, because of an unintended gunshot wound.”
Rep. Spitzer said his bill would still allow psychiatrists, who are more likely to encounter suicidal patients, to ask about gun ownership. But for most physicians, he said, asking about gun ownership is “not appropriate.” He suggested they could instead ask more “open-ended” questions about a person’s means to harm himself.
Florida passed a similar law in 2011. Challengers, including the American Academy of Family Physicians, challenged the law in court arguing that it infringed on doctors’ free speech rights. The 11th U.S. Circuit Court of Appeals in Atlanta last year upheld the law as constitutional.
“The Act simply informs physicians that inquiring about a private matter irrelevant to medical care isn’t part of the practice of good medicine and that, as always, a physician may face discipline for not practicing good medicine,” Judge Gerald Tjoflat wrote in the majority opinion.
Rep. Spitzer’s bill was referred Monday to the House Public Health Committee.
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans – and engages with them – about public policy, politics, government, and statewide issues.
While legislation expanding how and where Texans can carry weapons is dominating the state legislature this week, one state lawmaker is targeting the doctor’s office as a place to keep the federal government from learning who owns guns.
Over the objections of the medical community, state Rep. Stuart Spitzer, R-Kaufman, has filed a bill that would prohibit doctors from asking patients whether they own a firearm and makes the Texas Medical Board, which licenses physicians, responsible for doling out punishment.
“Pediatricians are asking children away from their parents, ‘Do you have guns in your house?’ and then reporting this on the electronic health records, and then the federal government, frankly, has access to who has guns and who doesn’t,” Rep. Spitzer said in a recent interview. He said he experienced the phenomenon firsthand when he took his daughter to the doctor, who asked her whether there were any guns in the house.
Rep. Spitzer, a surgeon, said he wanted to make sure that doctors “have the right not to ask that.”
But doctors’ groups say House Bill 2823 would squelch important discussions that are part of the physician-patient relationship.
“We, as physicians, ask all sorts of questions – about bike helmets and seat belts and swimming pool hazards, dangerous chemicals in the home, sexual behaviors, domestic violence. I could go on and on,” said Gary Floyd, a Fort Worth pediatrician and board member of the Texas Medical Association.
“All of that’s geared mainly to how we should direct our advice,” he said. “As a pediatric [emergency room] doc, one of the worst things you have to do is sit down with the family and explain that the child has died, or may never be the same, because of an unintended gunshot wound.”
Rep. Spitzer said his bill would still allow psychiatrists, who are more likely to encounter suicidal patients, to ask about gun ownership. But for most physicians, he said, asking about gun ownership is “not appropriate.” He suggested they could instead ask more “open-ended” questions about a person’s means to harm himself.
Florida passed a similar law in 2011. Challengers, including the American Academy of Family Physicians, challenged the law in court arguing that it infringed on doctors’ free speech rights. The 11th U.S. Circuit Court of Appeals in Atlanta last year upheld the law as constitutional.
“The Act simply informs physicians that inquiring about a private matter irrelevant to medical care isn’t part of the practice of good medicine and that, as always, a physician may face discipline for not practicing good medicine,” Judge Gerald Tjoflat wrote in the majority opinion.
Rep. Spitzer’s bill was referred Monday to the House Public Health Committee.
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans – and engages with them – about public policy, politics, government, and statewide issues.
While legislation expanding how and where Texans can carry weapons is dominating the state legislature this week, one state lawmaker is targeting the doctor’s office as a place to keep the federal government from learning who owns guns.
Over the objections of the medical community, state Rep. Stuart Spitzer, R-Kaufman, has filed a bill that would prohibit doctors from asking patients whether they own a firearm and makes the Texas Medical Board, which licenses physicians, responsible for doling out punishment.
“Pediatricians are asking children away from their parents, ‘Do you have guns in your house?’ and then reporting this on the electronic health records, and then the federal government, frankly, has access to who has guns and who doesn’t,” Rep. Spitzer said in a recent interview. He said he experienced the phenomenon firsthand when he took his daughter to the doctor, who asked her whether there were any guns in the house.
Rep. Spitzer, a surgeon, said he wanted to make sure that doctors “have the right not to ask that.”
But doctors’ groups say House Bill 2823 would squelch important discussions that are part of the physician-patient relationship.
“We, as physicians, ask all sorts of questions – about bike helmets and seat belts and swimming pool hazards, dangerous chemicals in the home, sexual behaviors, domestic violence. I could go on and on,” said Gary Floyd, a Fort Worth pediatrician and board member of the Texas Medical Association.
“All of that’s geared mainly to how we should direct our advice,” he said. “As a pediatric [emergency room] doc, one of the worst things you have to do is sit down with the family and explain that the child has died, or may never be the same, because of an unintended gunshot wound.”
Rep. Spitzer said his bill would still allow psychiatrists, who are more likely to encounter suicidal patients, to ask about gun ownership. But for most physicians, he said, asking about gun ownership is “not appropriate.” He suggested they could instead ask more “open-ended” questions about a person’s means to harm himself.
Florida passed a similar law in 2011. Challengers, including the American Academy of Family Physicians, challenged the law in court arguing that it infringed on doctors’ free speech rights. The 11th U.S. Circuit Court of Appeals in Atlanta last year upheld the law as constitutional.
“The Act simply informs physicians that inquiring about a private matter irrelevant to medical care isn’t part of the practice of good medicine and that, as always, a physician may face discipline for not practicing good medicine,” Judge Gerald Tjoflat wrote in the majority opinion.
Rep. Spitzer’s bill was referred Monday to the House Public Health Committee.
The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans – and engages with them – about public policy, politics, government, and statewide issues.
Bipartisan lawmakers have introduced a bill that would repeal the Medicare Sustainable Growth Rate (SGR) formula, this time with language that would reauthorize the Children’s Health Insurance Program (CHIP) for 2 years.
Leaders on the House Energy and Commerce and House Ways and Means committees on March 24 announced H.R. 2, the Medicare Access and CHIP Reauthorization Act. The proposal builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – by extending CHIP funding through fiscal 2017. Funding for the program expires in September. The Medicare Access and CHIP Reauthorization Act also includes 2-year reauthorization of the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all of which would expire in 2015.
Rep. Fred Upton
The changes would be paid for by income-related premium adjustments for Medicare parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for post–acute care providers.
The payment proposals of the bill reflect a working framework released by committee members March 20. A vote on the SGR package is expected this week.
The bill culminates years of efforts by lawmakers and stakeholders and will strengthen Medicare over the long term, according to Energy and Commerce Committee Chairman Fred Upton (R-Mich.).
“We can see the light at the end of the SGR tunnel – finally,” Rep. Upton said in a statement. “This responsible legislative package reflects years of bipartisan work, is a good deal for seniors, and a good deal for children, too. It’s time to put a stop once and for all to the repeated SGR crises and start to put Medicare on a stronger path forward for our seniors.”
Rep. Frank Pallone
The committee’s ranking member, Rep. Frank Pallone (D-N.J.) agreed.
“Finally, after a decade of trying, we have a bipartisan bill that will permanently repeal the flawed SGR and move Medicare to a health care system based on quality and efficiency, that is good for seniors and doctors alike,” Rep. Pallone said.
“As with any bipartisan effort, this legislation reflects give and take on both sides. However, we have come to a balanced compromise that will end uncertainty in the system, extend CHIP, fund Community Health Centers, and make permanent the Qualifying Individual (QI) program that helps low income seniors pay their Medicare premiums,” he added.
In addition to repealing the SGR, the final bill includes a 0.5% pay increase per year for the next 5 years; consolidates existing quality programs into a single value-based performance program; incentivizes physicians to use alternate payment models that focus on care coordination and preventive care; and pushes for more transparency of Medicare data for physicians, providers, and patients.
The latest bill comes a week before the current SGR patch expires on March 31. Without legislative action, physicians will see a 21% cut in Medicare pay.
Bipartisan lawmakers have introduced a bill that would repeal the Medicare Sustainable Growth Rate (SGR) formula, this time with language that would reauthorize the Children’s Health Insurance Program (CHIP) for 2 years.
Leaders on the House Energy and Commerce and House Ways and Means committees on March 24 announced H.R. 2, the Medicare Access and CHIP Reauthorization Act. The proposal builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – by extending CHIP funding through fiscal 2017. Funding for the program expires in September. The Medicare Access and CHIP Reauthorization Act also includes 2-year reauthorization of the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all of which would expire in 2015.
Rep. Fred Upton
The changes would be paid for by income-related premium adjustments for Medicare parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for post–acute care providers.
The payment proposals of the bill reflect a working framework released by committee members March 20. A vote on the SGR package is expected this week.
The bill culminates years of efforts by lawmakers and stakeholders and will strengthen Medicare over the long term, according to Energy and Commerce Committee Chairman Fred Upton (R-Mich.).
“We can see the light at the end of the SGR tunnel – finally,” Rep. Upton said in a statement. “This responsible legislative package reflects years of bipartisan work, is a good deal for seniors, and a good deal for children, too. It’s time to put a stop once and for all to the repeated SGR crises and start to put Medicare on a stronger path forward for our seniors.”
Rep. Frank Pallone
The committee’s ranking member, Rep. Frank Pallone (D-N.J.) agreed.
“Finally, after a decade of trying, we have a bipartisan bill that will permanently repeal the flawed SGR and move Medicare to a health care system based on quality and efficiency, that is good for seniors and doctors alike,” Rep. Pallone said.
“As with any bipartisan effort, this legislation reflects give and take on both sides. However, we have come to a balanced compromise that will end uncertainty in the system, extend CHIP, fund Community Health Centers, and make permanent the Qualifying Individual (QI) program that helps low income seniors pay their Medicare premiums,” he added.
In addition to repealing the SGR, the final bill includes a 0.5% pay increase per year for the next 5 years; consolidates existing quality programs into a single value-based performance program; incentivizes physicians to use alternate payment models that focus on care coordination and preventive care; and pushes for more transparency of Medicare data for physicians, providers, and patients.
The latest bill comes a week before the current SGR patch expires on March 31. Without legislative action, physicians will see a 21% cut in Medicare pay.
Bipartisan lawmakers have introduced a bill that would repeal the Medicare Sustainable Growth Rate (SGR) formula, this time with language that would reauthorize the Children’s Health Insurance Program (CHIP) for 2 years.
Leaders on the House Energy and Commerce and House Ways and Means committees on March 24 announced H.R. 2, the Medicare Access and CHIP Reauthorization Act. The proposal builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – by extending CHIP funding through fiscal 2017. Funding for the program expires in September. The Medicare Access and CHIP Reauthorization Act also includes 2-year reauthorization of the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all of which would expire in 2015.
Rep. Fred Upton
The changes would be paid for by income-related premium adjustments for Medicare parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for post–acute care providers.
The payment proposals of the bill reflect a working framework released by committee members March 20. A vote on the SGR package is expected this week.
The bill culminates years of efforts by lawmakers and stakeholders and will strengthen Medicare over the long term, according to Energy and Commerce Committee Chairman Fred Upton (R-Mich.).
“We can see the light at the end of the SGR tunnel – finally,” Rep. Upton said in a statement. “This responsible legislative package reflects years of bipartisan work, is a good deal for seniors, and a good deal for children, too. It’s time to put a stop once and for all to the repeated SGR crises and start to put Medicare on a stronger path forward for our seniors.”
Rep. Frank Pallone
The committee’s ranking member, Rep. Frank Pallone (D-N.J.) agreed.
“Finally, after a decade of trying, we have a bipartisan bill that will permanently repeal the flawed SGR and move Medicare to a health care system based on quality and efficiency, that is good for seniors and doctors alike,” Rep. Pallone said.
“As with any bipartisan effort, this legislation reflects give and take on both sides. However, we have come to a balanced compromise that will end uncertainty in the system, extend CHIP, fund Community Health Centers, and make permanent the Qualifying Individual (QI) program that helps low income seniors pay their Medicare premiums,” he added.
In addition to repealing the SGR, the final bill includes a 0.5% pay increase per year for the next 5 years; consolidates existing quality programs into a single value-based performance program; incentivizes physicians to use alternate payment models that focus on care coordination and preventive care; and pushes for more transparency of Medicare data for physicians, providers, and patients.
The latest bill comes a week before the current SGR patch expires on March 31. Without legislative action, physicians will see a 21% cut in Medicare pay.
