Healthcare Business News

Reform Update: Doc execs oppose linking SGR repeal to individual mandate

By Andis Robeznieks
Posted: March 24, 2014 - 3:30 pm ET

More than 80% of American College of Physician Executives participating in an online survey said they disagreed with the move by House Republicans to use delaying enforcement of the individual insurance mandate to pay for repealing the Medicare sustainable growth-rate formula.

Meanwhile, the American College of Surgeons took a slap at both political parties for their conduct of the SGR issue. “By invoking partisan offsets to pay for the sustainable growth-rate legislation, House Republicans and Senate Democrats have raised the possibility that neither bill will pass in the other chamber,” an ACS statement read. “The American College of Surgeons opposes the infusion of politics into the debate, particularly when the process to date has been conducted in a bipartisan, bicameral manner.”

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The House voted 238-181 this month to approve an SGR-repeal bill, which included an amendment to delay enforcement of the individual mandate for five years. A report from the nonpartisan Congressional Budget Office projected this would save the government $170 billion over 10 years and increase the U.S. uninsured population by 13 million in 2018.

The ACPE sent a March 19 survey invitation e-mail to its 11,000 members and, by the morning of March 24, more than 550 had participated. Almost 81% said an SGR repeal should not be linked to the individual mandate; 16.2% agreed with linking the two issues; and 3.3% were unsure.

“Repealing the outdated and ineffective SGR is not a partisan issue—it's what's best for healthcare,” Dr. Peter Angood, ACPE president and CEO, said in a news release. “I believe we all feel strongly it's time for a more permanent solution to our country's Medicare funding challenges.”

The White House had issued a statement prior to the House vote giving advance warning that it would veto legislation tying the SGR repeal to delaying enforcement of the individual mandate. But Senate Democratic leaders have refused to consider the House bill.

Meanwhile, the CBO estimated that a Senate version of the repeal bill would cost $180 billion over 10 years. Along with the SGR repeal, the bill—sponsored by new Finance Committee Chairman Sen. Ron Wyden (D-Ore.)—included Medicare “extenders” that would renew several expiring programs that benefit rural hospitals. It did not include a payment mechanism.

A 24% SGR-driven Medicare pay cut is set to take effect April 1 if Congress doesn't act by then. In the meantime, lawmakers may pass a legislative patch delaying implementation of the payment decrease—but that carries costs as well. The 16 SGR patches passed by Congress over the past 11 years have a total cost of $153.7 billion.

-Andis Robeznieks

New Medicare Advantage rules would protect seniors

Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other healthcare providers, Kaiser Health News reports.

The proposals follow UnitedHealthcare's decision to drop thousands of doctors last fall from its Medicare Advantage plans in at least 10 states.

The government's response is part of the 148-page announcement of proposed rules and payment rates for next year's Medicare Advantage plans released last month by the CMS.

The proposals would give beneficiaries more than 30 days' advance notice of network changes and providers at least 60 days' advance notice of a contract termination.

The CMS is soliciting suggestions on how plans should prove that their reconfigured networks are adequate.

Although the announcement does not name any insurance companies, officials prefaced the proposals by writing, "Recent significant mid-year changes to (Medicare Advantage organizations') provider networks have prompted CMS to reexamine its current guidance on these requirements and to consider augmenting such guidance in response to such changes."

Medicare Advantage rules allow beneficiaries to change plans if they move out of the coverage area or for other special reasons, but not if they lose their doctors or hospitals. Otherwise, they can switch plans only once a year, during the annual seven-week fall enrollment period. Since most beneficiaries are locked into their plans, the CMS is considering whether to restrict insurers' ability to drop doctors during the plan year.

If insurers expect to drop providers in the coming year, they should say so in the letter highlighting changes that they are required to send to plan members every year before the open enrollment season. The CMS would also add "required language" to the letter explaining patients' rights in the event that network providers leave the plan during the plan year.

Final rules are expected as early as April 7.

"These are exactly the things we talked about with CMS back in the fall," said Mark Thompson, executive director of the Fairfield County (Conn.) Medical Association, which, along with the Hartford County Medical Association, sued UnitedHealthcare to block the terminations. The American Medical Association and 35 state medical associations and physician advocacy groups filed legal papers in support of the doctors.

"Someone was paying attention and listening to us," Thompson said.

Representatives for UnitedHealthcare and Humana, the two leading Medicare Advantage insurers, declined to answer questions or provide copies of their comments to the CMS related to the proposals. UnitedHealthcare said earlier that the cancellations were partly the result of cuts in federal reimbursements required by the Patient Protection and Affordable Care Act and also part of an effort to improve quality and reduce costs.

However, America's Health Insurance Plans, which represents more than 1,300 health insurers, warned the CMS that the proposed rules could hinder insurers' contract negotiations with providers, which "occur throughout the year" and could also weaken enforcement of contract terms that allow for provider terminations. In addition, notifying beneficiaries of potential terminations before contracts may be successfully completed "would be unnecessarily disruptive," the group says.

-Kaiser Health News

Doc groups warns of workforce shortage

The two largest primary-care physician organizations cheered the results of the 2014 National Resident Matching Program, but added that they were still concerned about meeting the nation's future healthcare workforce needs.

The 137,000-member American College of Physicians, which represents internal medicine, noted that 3,167 U.S. medical school seniors were matched to an internist training program and how that number has risen steadily since 2010. But the ACP also lamented that only 20% to 25% eventually specialize in general internal medicine while the rest go into a subspecialty such as cardiology or gastroenterology.

"While the number of U.S. medical students choosing internal medicine residencies continues in an upward trend, the exorbitant cost of medical education with the resulting financial burden on medical students and residents along with problematic payment models and administrative hassles are barriers to a career in general internal medicine and primary care," Dr. Patrick Alguire, ACP senior vice president for medical education, said in a news release.

The 110,600-member American Academy of Family Physicians noted that 1,416 U.S. medical school seniors matched with a family medicine residency program, which is 42 more than last year and 333 more since 2009.

“As each new first-year class of family medicine residents grows, so does our ability to meet the need for high-quality primary medical care,” Dr. Reid Blackwelder, AAFP president, said in a news release. “We must have increased efforts of our legislators to incentivize primary care as one critical step to attracting more medical students into family medicine so that with next year's match we can celebrate further steps in the right direction.”

Med school seniors found out March 21 which program they matched. Match Day has become a celebratory event with ceremonies being held where classmates open their match letters simultaneously.

These moments have been recorded and distributed via social media. The Association of American Medical Colleges and the American Medical Association has collected and posted tweets, photos and videos on Storify pages.

Among the images tweeted on Match Day 2014 was a photo of an Indiana University School of Medicine senior proposing to a fellow student. Names were not released, but the tweet did inform viewers that “She said yes!”

Though the names weren't given in the tweet, the school did reveal that it was Joel Franco, who's headed to a otolaryngology residency at St. Louis University Medical Center, who proposed, and Tanya Devnani, who will train in internal medicine at Barnes Jewish Hospital in St. Louis, who accepted.

-Andis Robeznieks

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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