Photo: Rep. Jim McGovern Tours UMass Memorial
Proposed Federal Budget Includes 630 Billion Dollars for Healthcare Reform
President Obama’s proposed Federal budget sets aside a “reserve” fund of more than $630 billion over ten years that will be dedicated towards financing healthcare initiatives including reform of the physician pay system and the adoption of Health Information Technology.
The proposed budget, outlined in a summary document released Feb. 26, is financed by increasing taxes on families earning more than $250,000 and individuals earning more than $200,000 annually, as well as through a series of Medicare and Medicaid policy changes including substantial funding cuts to Medicare Advantage plans.
Included in the budget blueprint are provisions that would:
- Set aside nearly $330 billion over 10 years for the purpose of permanently fixing Medicare’s physician payment system.
- Address financial conflicts of interest in physician specialty hospitals, which may refer to efforts to pass legislation closing a loophole in the physician self-referral law that allows physicians to refer Medicare patients to hospitals in which they have ownership interests.
- Enable physicians to form voluntary groups which will coordinate care for Medicare beneficiaries and allow them to receive performance-based payments. These provisions may potentially lay the foundation for a more extensive “Medical Home” policy in the coming months, as outlined in the related Statline article “Patient-Centered Medical Home Model Gains Traction in Healthcare Reform.”
- Ensure appropriate Medicaid payments through use of the National Correct Coding Initiative, a CMS program to control improper coding and inappropriate payment in Part B claims, for a projected savings of $620 million over 10 years.
“The priority this budget places on reforming Medicare’s physician payment system is very encouraging,” said Andrew Horvath, MD, FCAP, chair of the Council on Government and Professional Affairs. “Relying on the current flawed Sustainable Growth Rate Formula model, physicians’ Medicare reimbursement is scheduled to be reduced 20 percent in 2010. We need action now to find a permanent solution that doesn’t require Congressional intervention each year, and it looks like the White House is prepared to move forward.”
The complete budget is expected to be released in April.
Technical Problem with Pathology Code for PQRI, CMS
A technical problem affecting 20 Physician Quality Reporting Initiative quality-data codes, including the breast and colon cancer code, has caused some carriers to reject submissions for the first three months of 2009. The Centers for Medicare and Medicaid Services has issued instructions on how physicians may address the problem.
In most cases the status error caused line items containing the breast and colon cancer code to be rejected as unprocessable. CMS anticipates all carriers will be able to accept the affected codes within the next three weeks.
CMS announced it will exclude from the reporting denominator all cases for dates when the carriers could not accept the affected CPT II codes, unless inclusion of cases is more favorable to the physician.
In its notice, CMS provided two approaches to addressing the errors based on whether or not it is beneficial for the physician to seek correction of the affected codes.
The College will continue to monitor this problem, and will publish updates in upcoming issues of Statline.
Patient-Centered Medical Home Model Demonstrations
The need to reform healthcare to improve the coordination and quality of medical care continues to be a top priority for legislators and regulatory agencies, and the concept of the Medical Home has been widely supported by medical organizations and members of Congress to address that need.
The Patient-Centered Medical Home model provides patients access to a primary care provider who is responsible for coordinating services amongst specialists’ offices, hospitals and laboratories, as well as across the different types of care.
The central premise of the Medical Home is that it will provide a higher degree of personalized care coordination, continual access to physicians beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs—which will result in a continuous comprehensive model.
Congress recently authorized a three-year Medical Home demonstration project, which CMS is in the process of implementing. Reimbursement to primary care physicians for coordinating patient care in the Medical Home will be based off of a two-tiered “per-member per-month” care management fee, with fees adjusted using a Hierarchical Condition Code to reflect the severity and burden to the physician.
Other Medical Home demonstration projects already in existence, include the Geisinger Medical Home, National Committee for Quality Assurance’s Physician Practice Connections-Patient Centered Medical Home (PPC®-PCMH™) and components of the Community Care for North Carolina program. Other organizations, such as the Commonwealth Fund, are also proposing alternate models to the one proposed by CMS.
The Medical Home concept and other aspects of coordinated care, such as disease management, are expected to be addressed in a broader context as part of the health care reform debate in Congress.
While the College supports the concept of the Medical Home, it will require the widespread adoption of health information technology for care management including electronic health records, along with adequate payment models for medical specialties.
CAP will continue to work with other medical organizations, Congress and CMS as the concept of the Medical Home is developed, to ensure that the critical physician role of pathologists is best utilized in providing quality, affordable healthcare to patients.
For more information on the CMS Medical Home demonstration project, please visit
the project website.
Kansas Governor Tapped for HHS Nomination, Former Clinton Advisor Named Health Czar
Gov. Kathleen Sebelius of Kansas was appointed by President Obama as the nominee for Secretary of Health and Human Services March 1, while former Clinton Administration advisor Nancy-Ann DeParle was named Health Czar.
Obama’s decision to appoint both an HHS Secretary and a Health Czar sends a strong message that any federal health care reform initiative will be driven by the White House.
Governor Sebelius served eight years as the Kansas insurance commissioner and, if confirmed by Congress, will have a post within the President’s Cabinet and oversee 11 agencies including the Centers for Medicare and Medicaid Services, the National Institutes of Health and the Centers for Disease Control and Prevention.
DeParle, whose role will not face Congressional approval, served as the Tennessee Commissioner of Human Services, and was a Clinton Administration healthcare adviser at HHS, the White House Office of Management and Budget and CMS’ predecessor, the Health Care Financing Administration.
The Health Czar, a newly created position, will serve as the President’s chief point person on health care reform in an administration that already includes advisors from the National Economic Council, Office of Management and Budget, Health and Human Services, and the Domestic Policy Council.
Help Ensure Our Seat in the House of Medicine – Act Now!
The following is a message from William V. Harrer, MD, FCAP, and CAP Delegate to the American Medical Association House of Delegates:
Every five years the College’s membership in the American Medical Association comes up for review. To ensure that pathology has a seat in the AMA House of Delegates, CAP must demonstrate that an adequate number of its members are AMA members who designate the College as their voting organization.
As the leading voices for pathologists, the College and the AMA, have an important opportunity to advocate for our profession on healthcare reform, including Medicare physician payment, regulatory relief, and health care delivery system changes. As a specialty society within the AMA, CAP joins with states and other national medical specialties to ensure that medicine speaks with a strong national voice.
You action is needed now!
If you are a member of both the AMA and CAP, please go to the Members Only page
of the AMA website. After you log in, go to “Specialty Society Representation Ballot” and designate the College as your voting organization.
If you are not currently a member, I encourage you help ensure our seat in the House of Medicine and join the AMA. Participation is an important and meaningful way that CAP members can help pathologists address challenges facing public health, public policy, and professional affairs.
CAP Provides Testimony on Pathologists Role in Genomic Tests for Patients
The College provided testimony to the Centers for Medicare and Medicaid Services’ Medicare Evidence Development & Coverage Advisory Committee (MedCAC) Feb. 25 highlighting the role of pathologists in developing, delivering and interpreting genomic tests for patients.
Mary Elizabeth Fowkes, MD, PhD, FCAP, spoke on behalf of CAP, explaining how the pathologists’ role ensures the “right test for the right person at the right time,” and how the development of molecular tests has allowed for the diagnostic assessment of diseases in both hematologic and solid tissue tumors.
“As medical specialists in the diagnosis of disease, pathologists have a long track record of practicing evidence-based medicine through the development of appropriate laboratory tests and selection of alternative diagnostic methods,” said Dr. Fowkes, who is Professor of Pathology at The Mount Sinai Hospital and School of Medicine in Manhattan, NY.
The MedCAC hearing focused on requirements for evidence to determine if diagnostic use of genomic testing in beneficiaries with signs or symptoms of disease improves health outcomes in Medicare beneficiaries. CMS is then expected May 6, 2009, to convene a public meeting of the MEDCAC entitled “Screening Genetic Tests.”
To view the complete testimony, visit the CAP Advocacy webpage under “Comments to Regulatory Agencies.”
Reminder: Scholarship Applications Now Available for CAP’s
2009 Advocacy School
Scholarship applications are now available for 2009 Advocacy School, which will be held May 4 - May 6 in Washington, DC.
With several legislative issues affecting pathology expected to be acted on, such as cuts to Medicare physician payments and the adoption of Health Information Technology, this is the time to become politically involved.
“Grassroots advocacy is the most powerful force in the legislative process,” said Richard Gomez, MD, FCAP, chair of the Federal and State Affairs Committee. “As health care reform is addressed by the current administration and Congress, it is extremely important for pathologists to engage with their members of Congress so they know who we are and the importance of our legislative agenda and issues.”
Advocacy School provides members an outstanding opportunity to receive in-depth political advocacy training, learn about the College’s key issues and the legislative process, hear from Congressional guest speakers and meet with lawmakers and their staff.
Last year, Advocacy School graduates met with more than 100 House and Senate offices on key legislative issues. This year promises to bring critical new pathology issues before Congress.
If you would like to attend the CAP Advocacy School this spring, download the application from the CAP Web site (PDF, 81 K) (Word, 152 K). For more information contact Susan Askew by e-mail or at 202-354-7105.
(For Statline reprint permission, please contact Justin Herman.)
202-354-7100 • 202-354-7155 (fax) • 800-392-9994