American College of Rheumatology

The Current State of Health Care Reform

Aiken HackettDirector, Government Affairs

Health Care Reform

Objectives

• 2010 Physician Fee Schedule

• Senate Health Care Reform

• House Health Care Reform

Medicare Physician Fee Schedule

2010 Proposed Rule • Elimination of Consultation Codes

• Decrease of Infusion payments 25%

• Continuation of PQRI

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

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

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.

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)

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.

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.

Senate HELP Bill

Other Provisions

• Follow-on biologics

• Loan repayment program for pediatric sub-specialties

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.

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

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

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

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

H.R. 3200 Tri-Committee Bill

Imaging

• Calls for study on DXA utilization

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

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.

  

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.

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.

American College of Rheumatology

Questions?

ACR Government Affairs Department Patton Boggs LLP