Physician Groups Testify at House Hearing on SGR

On July 24, NASS staff attended a House Ways and Means Health Subcommittee hearing on developing a new Medicare reimbursement system for physicians. In total six physicians groups – including one association representing specialty doctors – highlighted various mechanisms that could be part of a new Medicare payment system.

Panelists at the hearing said they all agreed that a new payment system should focus on improving the quality of care of patients and move away from the current fee-for-service system. Others noted that just repealing the sustainable growth rate (SGR) formula in the current system wouldn’t be enough and that Congress should implement measures that reward physicians for participating in quality improvement and other value-based payment programs. Among other recommendations, panelists urged committee Members to consider patient-centered medical homes, as well as bundled and global payment programs, as ways to improve payment and care coordination between providers.

Subcommittee Chairman Wally Herger (R-CA) agreed with witnesses who testified that better alignment of existing provider incentive programs such as e-prescribing, electronic medicals records and the value-based payment modifier was needed. Provider groups cited many of Medicare’s current provider incentive programs as areas of concerns for doctors as these programs generally have not been developed or led by the physician community.

To access a recording of this hearing, click here.

House Spending Bill Delayed to Make Way for Continuing Resolution

The House Appropriations Committee signaled that it will not mark up the Labor, Health and Human Services, and Education (Labor, HHS) spending bill that was passed last week by the Subcommittee. As previously reported, the House Appropriations Subcommittee on Labor, HHS, approved a fiscal year 2013 funding bill that would eliminate spending to implement the health reform law and repeals existing funding from programs established under the law. If signed into law, the bill would provide $150 billion for Labor, Health, and Education programs over the next fiscal year, which begins October 1, and would have reduced spending levels in the programs by $6.3 billion over FY 2012 funding levels.

This latest development comes amid reports that House Republican leaders are shifting their attention toward a stop-gap measure that would continue to fund the government after the current fiscal year ends. At this time Republican leaders in the House are said to be considering other options, including a three-month continuing resolution (CR) that would avert a government shut down until after the upcoming November elections. Sources inform NASS that House Republicans will likely wait until after Congress returns from its August recess to introduce a resolution that will keep the government running passed the September 30 deadline.

CMS Administrator Says Health Insurance Exchanges Will Be Operable by 2014

Last week, Michael Hash, interim director of the Center for Consumer Information and Insurance Oversight (CIIO) at the Centers for Medicare and Medicaid (CMS) said that federal exchanges will be ready to operate by 2014 in states that have not created their own by that date. The creation of state exchanges has been at the center of controversy since the Affordable Care Act (ACA) was signed into law. A provision in the ACA requires that if states cannot develop a functioning exchange by 2014, then the federal government will step in and operate an exchange of its own.

As of now, 34 states and the District of Columbia have received $850 million in grants to establish state-based exchanges. States can apply for the grants through 2014 to establish exchanges after that date. Only 14 states and the District of Columbia have passed legislation to establish an exchange, while eight other states have decided not to establish exchanges.

CBO Releases Report on Costs the of ACA in Response to Supreme Court Ruling

In a report released last week, the Congressional Budget Office (CBO) projected that the cost of the Affordable Care Act (ACA) will drop by $84 billion as a result of the recent Supreme Court ruling. The court’s ruling now allows states the ability to opt out of the law’s requirement for individual states to expand coverage for Medicaid enrollees.

The CBO also projects that the court’s decision will result in 6 million fewer enrollees in Medicaid and the Children’s Health Insurance Program, of which 3 million more enrollees will participate in the insurance exchanges that will be launched in 2014 and about 3 million others will remain uninsured.

To access this report, click here.

Federal Agencies Announce New Anti-Fraud Initiative

The departments of Health and Human Services and Justice announced last week that a new partnership involving the federal government, states, insurers and anti-fraud groups has been established to help reduce future health care fraud. This partnership allows stakeholders to share data and best practices to improve detection and prevent payment of fraudulent health care billings occurring across public and private payers. Many of the details of the initiative are still being worked out, however, working groups have been meeting to establish more specifics of the initiative, and this work is expected to carry over into the fall.