TMA EVPGram

The U.S. House of Representatives today (Nov. 19, 2009) passed HR 3961 on a 243-183 vote. The bill would stop the 21-percent cut in physicians' Medicare payments scheduled for Jan. 1. It would replace the Medicare Sustainable Growth Rate (SGR) with a new formula that is still based on growth in the gross domestic product. It also would set future payment rate changes separately for evaluation and management services and for procedural codes. House passage of HR 3961 is critical if a permanent SGR fix is going to be included in Congress' final health reform package.

Unfortunately, Capitol Hill partisan politics is complicating what already is a terribly complicated problem of health system reform. Rep. Michael Burgess, MD (R-Lewisville), was the only Republican to vote for HR 3961. I am terribly proud of Dr. Burgess for his courageous stance, which might expose him to some intraparty consequences. As the most knowledgeable member of Congress on Medicare, he introduces bills year after year to replace the SGR with a formula that is based on physicians' cost of caring for patients. He took the time early this morning to consult with TMA leaders about today's vote and what it means to Texas physicians and your patients.

"This bill is not the best way to fix the long-standing physician reimbursement problem," Dr. Burgess said after the vote. "The appropriate resolution is HR 3693, the Ensuring the Future Physician Workforce Act, which would finally make things right for our nation's doctors. I also do not think it is right to continue to pass massive spending bills that add to our country's record deficit with no rational payment plan in place. However, I think it is very unlikely that today's bill will ever become law, since the Senate has already soundly rejected a similar plan. Because of this, today's vote is largely symbolic, and with my 'yes' vote, I stand committed to America's doctors, the millions of seniors they care for, and TRICARE recipients, to fix this problem."

I also want to thank these Texas Democrats who voted for the bill: Reps. Henry Cuellar of Laredo, Lloyd Doggett of Austin, Charlie Gonzalez of San Antonio, Al Green of Houston, Gene Green of Houston, Rubén Hinojosa of Mercedes, Sheila Jackson Lee of Houston, Eddie Bernice Johnson of Dallas, Solomon Ortiz of Corpus Christi, Silvestre Reyes of El Paso, and Ciro Rodriguez of San Antonio.

(From TMA EVPGram, special issue, Nov. 19, 2009)

Despite calls from a vocal minority to the contrary, the American Medical Association House of Delegates backed the organization’s position in support of health system reform. “The time to make health system reform a reality is now,” said AMA President Jim Rohack, MD. The house adopted language requiring AMA to “actively and publicly” oppose or support certain details of reform legislation (PDF), pushing AMA leaders to stay true to existing association policy. “We shouldn’t have to move around in secret in the halls of Capitol Hill,” said Peter Levine, MD, a delegate from Washington, D.C. We should be leading and not hiding behind the shadows of people in Washington.” During extensive debate, the delegates:

• Adopted language directly from TMA’s Texas Medicare Manifesto stating that “health care reform must include replacing the Sustainable Growth Rate (SGR) with a Medicare physician payment system that automatically keeps pace with the cost of running a practice, and is backed by a fair, stable funding formula;”
• Included strong support for effective medical liability reform; and
• Opposed unscientific measurements of physicians’ clinical outcomes and the establishment of a new Medicare bureaucracy that could set payment rates without congressional approval.

But a call for AMA to “actively and publicly oppose any new public health insurance option” failed 315 to 199. “It is bad tactics to give away all of your positions when you are playing a poker game such as we are with Congress,” said Barbara McAneny, MD, chair of the AMA Council on Medical Service. And, in the most telling action, the delegates defeated 350 to 167 language stating that AMA did not endorse HR 3962, the broad reform bill that the U.S. House of Representatives approved just days earlier with AMA support. Read complete coverage of the AMA house debate on TMA’s Blogged Arteries. We’ll also have our usual wrap-up of the full meeting in Texas Medicine.

Congress returns tomorrow from its Veterans Day recess with two big health system reform items on its pre-Thanksgiving plate. TMA joined AMA and more than 100 national specialty and state societies (PDF) in calling on the House to pass HR 3961. The bill would stop the 21-percent cut in physicians’ Medicare payments scheduled for Jan. 1. It would replace the SGR with a new formula that is still based on general inflation rates. It also would set future payment rate changes separately for evaluation and management services and for procedural codes. House passage of HR 3961 is critical if a permanent SGR fix is going to be included in Congress’ final health reform package. Across the rotunda, U.S. Senate leaders are scheduled to unveil their new comprehensive reform bill and begin what many expect will be a long and protracted debate. Be on the lookout for a TMA call to contact Texas Sens. John Cornyn and Kay Bailey Hutchison about that bill.

More than 2,100 TMA members have answered our online survey on health system reform. Have you? Please take about five minutes to respond to the e-mail invitation to take the survey. “TMA’s strength flows directly from our grassroots — our members,” said TMA President Bill Fleming, MD. “That’s why we need your feedback.” The deadline is 11 am Central Standard Time Thursday. We will publish the results soon after that.

Texas has ordered more than 3 million doses of the H1N1 influenza vaccine. State health officials urge physicians to continue to focus on immunizing priority populations such as pregnant women, children under 4, and health care workers. Read TMA’s weekly Flu Fighters’ Hotline to keep up with the latest on the spread of H1N1, how to administer and bill for the vaccine, answers to patients’ commonly asked questions, and other tips for your practice.

By a five-vote margin, the U.S. House of Representatives late Saturday night passed HR 3962, Speaker Nancy Pelosi’s health system reform bill. It was mostly a party-line vote. Among Texans, all Republican representatives and Rep. Chet Edwards (D-Waco) voted against it; all the other Democrats voted for it. The bill won the American Medical Association’s support two days before the vote. A separate bill, HR 3961 — which won’t be considered until next week — eliminates the Medicare Sustainable Growth Rate (SGR) formula for physician payments with a new system that is still based on general inflation rates. It also would set future payment rate changes separately for evaluation and management services and for procedural codes. House passage of HR 3961 is, however, critical if a permanent SGR fix is going to be included in Congress’ final health reform package. HR 3962 includes a public insurance option with negotiable payment rates, a Medicare bonus for primary care practices, quite a few administrative simplifications for physicians’ dealings with insurance companies, and fines for most employers who do not offer health insurance benefits and for individuals who do not obtain insurance. It would create more than 100 new independent federal agencies to regulate health care. It would virtually prohibit the opening of any new physician-owned hospitals or growth of existing ones. HR 3962 does not include strong medical liability reforms. Thanks to an amendment from Rep. Henry Cuellar (D-Laredo), it does include some protections against federal preemption of Texas’ cap on noneconomic damages in health care liability cases. But experts from the Texas Medical Liability Trust caution that those protections are not broad enough.

With large numbers of delegates incensed that AMA supported HR 3962, the AMA House of Delegates convened this weekend in Houston. Debate in a reference committee dealing with legislative matters stretched on for more than eight hours Sunday as delegates from various state and specialty societies both praised and lambasted AMA for supporting the bill. (See our live blog of the reference committee debate.) Much of the most constructive discussion focused on making sure that AMA spells out specifically what it does and does not like in the bill, on what to do with it next in the Senate, and on how medicine can make sure that HR 3961 or some other permanent Medicare payment fix is passed before the 21-percent cuts in physician payments take effect Jan. 1. The just-released recommendation from the reference committee (PDF) does not deal with the question of AMA’s support for the bill, but sticks to guiding principles, positions that AMA supports, and issues of concern. Among specific items of interest from the committee report:

• The language on replacing the SGR copies TMA’s Texas Medicare Manifesto: “National health care reform must include replacing the SGR with a Medicare physician payment system that automatically keeps pace with the cost of running a practice, and is backed by a fair, stable funding formula.”
• “A single payer, government-run health care system is not in the best interest of the country and must not be part of national health system reform.”
• Health reform legislation must not expose physicians to new legal liability, and “failure to follow each and every clinical practice guideline should not be used to create a presumption of negligence.”

House of Delegates debate on the recommendations is scheduled for this afternoon. Once again TMA will cover the proceedings live via Blogged Arteries. Tune in.