Congress returns to Washington this month, and there will be many new faces on Capitol Hill. The recent midterm election will bring significant changes to the 112th Congress, leaving many to wonder what this new dynamic means for health policy.
Many Republicans ran on a platform of repealing the healthcare law; however, with Democrats still holding the majority in the Senate and a lack of votes to override a veto from President Barack Obama, repealing the healthcare law is highly improbable. With that option off the table, Republicans have two choices: Deny funding for new programs and delay implementation of the law, or take a piecemeal approach to modifying the law. Delaying implementation of the law through the appropriations process will be cumbersome at best, so the most viable option is to revise the law section by section. The ACR will work diligently to educate lawmakers about our priorities for reforming the healthcare reform law, which are:
- Pediatric Subspecialty Loan Repayment Program: The healthcare law authorizes the creation of a pediatric subspecialty loan repayment program for pediatric subspecialists who work in underserved areas. Rep. Rosa DeLauro (D-CT) and Sen. Sherrod Brown (D-OH) have requested $5 million in funding for the program for fiscal year 2011. The ACR will continue to work with other specialty societies to secure funding for this vital program.
- Increased Reimbursement for DEXA Scans: Reimbursement for dual energy X-ray absorptiometry (DEXA) scans has increased to 70% of 2006 levels for 2011; however, reimbursements are scheduled to drastically decrease in 2012. The ACR will work with Rep. Shelley Berkley (D-NV) and Rep. Michael Burgess, MD (R-TX) to reintroduce the Medicare Fracture Prevention and Osteoporosis Testing Act, which would permanently restore payments for DEXA screenings to the 2006 rate.
- Independent Payment Advisory Board: In 2014, the law establishes a 15-member Independent Payment Advisory Board charged with recommending reductions in Medicare spending if spending exceeds a target growth rate. The ACR is opposed to any provisions that would empower an independent commission to mandate payment cuts for physicians and any other payment reductions under the Medicare physician payment system.
- PQRI Penalties: Penalties for nonparticipation in the Physician Quality Reporting Initiative (PQRI) will begin in 2015. The capacity to participate in PQRI proves difficult for many rheumatology professionals, especially those not using electronic medical records. It also adds additional paperwork for physicians and health professionals already overloaded with paperwork. The ACR supports the creation and reporting of quality measures but is opposed to penalizing providers for not participating in PQRI.
- Form 1099 Reporting: As of 2012, businesses will be required to report all payments over $600 for services or merchandise to the IRS on a Form 1099. The additional paperwork will add unnecessary costs to small and solo physician practices.
In addition to working with the new Congress to improve the healthcare law, the ACR will continue to pursue our legislative priorities:
The Physician Quality Reporting Initiative (PRQI) is a voluntary quality reporting program initiated by the Centers for Medicare and Medicaid Services (CMS) in 2007. CMS provides bonus payments to eligible providers who successfully report on applicable PQRI measures. For 2010, rheumatologists who successfully participate in PQRI can earn an incentive payment of 2% of the…
“To Err is Human,” published by the Institute of Medicine in 1999, set off a firestorm of quality initiatives when it announced that at least 44,000 to 98,000 people die in hospitals every year because of medical errors. The first quality initiatives, which were aimed at hospitals, have now trickled down to physician practices. For two years there have been reports of payors moving to a pay-for-performance system or value-based purchasing.
It is not too late to participate in the Centers for Medicare & Medicaid Services’ (CMS) 2009 Physician Quality Reporting Initiative (PRQI). Participation is voluntary, but providers who participate now will better prepare themselves for probable future reporting requirements while qualifying for an incentive payment from CMS.
Complex requirements and confusion typify start of Medicare quality initiative