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Rad-Specific details of House Heath Care Bill
I’ve seen bits and pieces of this bill posted, but I thought I’d give a listing of the details I found while searching through it. Many of them relate specifically to Radiology, but others are more general. I’ll try to prioritize them.
The full text is here: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf
sec 1121, pg 238. First of all, the SGR is abolished, but the TGR (“target growth rate”) is established. The TGR is the new SGR. The “reform” is to make it specific to each physician category, including separate categories for preventive medicine and diagnostic E/M. This does not differ based on specialty. The effect will be similar to the SGR, but with a different name.
Furthermore, this TGR is not individually subject to congressional approval as is the case with the current SGR. Luckily, we’ll still have the other physician groups along with us to fight the changes, but it’ll be much more difficult. Good news is that we probably won’t have to worry about the “surtax on high income individuals”.
Pg 121 , sec 223. Physician payment rates for the Public Option will initially be set at the same level as the current base rates for Medicare parts A and B. Note that the TGR will adjust this down as time goes on, MDs will get a grand 5% bonus over Medicare rates for participating in the public option and Medicare during the first 3 years. If I’m reading this wrong, please let me know.
pg 274, line 2. Utilization rate for advanced imaging equipment changed from 50% to 75%. Also, the discount for imaging consecutive body parts will increase to 50% from the current 25% discount. This will hit outpatient imaging centers hard, and will make imaging Medicare patients unprofitable, forcing a decision of whether or not to continue imaging them. This will take effect Jan 1, 2011.
p 124, sec 223, (f). The Limitations on Review section states that there will be no administrative or judicial review of any payment rate or other methodology established. There can be no review or lawsuit regarding govt monopoly price-fixing.
Pg 30 Sec 123 of HC bill – The Health Benefits Advisory Committee will determine exactly what benefits insurance plans are allowed to offer. The committee will be composed of the Surgeon General of the United States, along with 18 members appointed by the President, and 9 members appointed by the Comptroller of the United States (GAO). Thats 27 political appointees, and only 1 of these 27 people is required to be a practicing physician or other health professional. Your heath care coverage WILL be decided and rationed by a group of 27 politicians, including a token of at least one practicing health professional which may be a Physician, Physician assistant, or Nurse Practitioner.
This committee will determine the rates of insurance and the insurance coverage for all Americans, whether public “option” or private insurance. All Americans will have their health care coverage dictated and rationed by government bean counters. Taking private insurance will not protect you from their control. Private insurers are subject to the same rules.
Pg 17, sec 102. The President says that if you like your current plan, you can keep it. According to sec 102, pg 17, line 11, that promise will only be kept for 5 years. After that, I guess it’s not his problem anymore.
pg 111, sec 208 allows States to instead create their own Health Insurance Exchanges, rather than the Federal Exchange, within limitations imposed by the Commissioner. (I couldn’t figure out whether the States are required to include the public option, I’m not sure it’s explicitly stated. That might save some of us to some degree.)
pg 466, line 7, sec 1302. The payments for the medical home are essentially capitated monthly payments made at a certain rate per patient per month to the Primary care physician or nurse practitioner. This is the HMO of the 1990s, except with the fraud, waste, and abuse evident in every Federal Govt program that may make the HMO debacle of the 90s seem tame by comparison. This gives doctors and Nurse Practitioners an incentive to provide less care, rather than better care.
pf 445, line 6, sec 1301 redefines the term physician as any individual who furnishes services for which payment may be made as physician services. sec 1302 repeatedly refers to Primary care providers in charge of the medical Home as being either physicians or Nurse Practitioners. This seems to allow NPs to be the independent practitioners they have sought to be, allowed to practice without physician supervision.
pg 127, sec 225 This seems to allow non-physicians – ?Nurse Practitioners and PAs? to bill Medicare physician rates for providing care to public option patients. Don’t know whether or not this is a change from current practice.
pg 203, line 13, sec 59c surcharge on high-income individuals. The starting point is a heavily debated topic, but the govt is given free reign to change this at a later date as it sees fit, in addition to inflation-adjusted increases. The statement is made that the tax imposed under this section shall not be treated as tax …. Not sure exactly what it means, but I wouldnt consider it a good thing. If it feels like a tax, call it a tax.
pg272, sec 1145. Hospitals will be categorized in a manner similar to the physician service categories. Higher cost hospital types will be paid less ( I am assuming a bundling mechanism). This specifically relates to cancer hospitals and ambulatory hospitals. This affects Rads in the sense that many people feel that our payments will eventually be bundled, regardless of our current group structure. Bundled Rad payments from a hospital generally felt to be more expensive would almost certainly be paid at a lower rate.
pg 320 Hospitals are not allowed to expand capacity (beds, Operating rooms, procedure rooms) without permission from the secretary, Govt appointee. A hospital cannot reapply for expansion more frequently than every 2 years. direct input from community required for approval of request to expand. Other stringent rules are outlined on pg 324,325 to determine whether or not the expansion will be allowed by the Federal govt. Hospital expansion will no longer be a matter of supply and demand, and will no longer be up to the investors. The rules favor expansion only in rural and underserved areas. There are certainly some good things that will come from this, but it seems to be quite an intrusive, bulky, wasteful, bureaucratic system they’re creating.
pg 317 seems to effectively close the Stark Law loopholes, but this seems unlikely to be retained in the final bill.
Pg 167 Lines 18-23 ANY individual who doesnt have acceptable health care according to the Govt will be taxed 2.5% of income.
Pg 149 Lines 16-24 ANY Employer with payroll 400k & above who does not provide insurance for employee pays 8% tax on all payroll. This number may change in the final bill.
pg 150 Lines 9-13 Businesses with payroll between 251k & 400k who don’t provide insurance pay 2-6% tax on all payroll. These numbers will likely change in the final bill.
Sec 312, pg 146. Employers will now be required to provide health care coverage to part time employees.
pg 43, sec 142. The Commissioner will audit the Insurance companies at their own expense to investigate complaints, and at regularly scheduled intervals. This will, of course, make them less competitive.
Pg 58 and 59, sec 1173A. Allows electronic access with automated payment to ensure that all bills are paid at the time of performance of the procedure. This seems to state that no procedure will be billed for later payment. Not entirely a bad thing. We’ll be paid but a pittance, but the pittance paid promptly.
Call and write your representatives and Senators at their local offices, and try your best to speak directly with them, or at least with a legislative assistant. If you live in the district of a “blue Dog Democrat”, let them hear your opinion. If you have relatives or friends in their districts, make sure they understand how this will destroy the incentive in American Medicine and how it will directly limit their access to care, and make sure they understand how important it is for them to speak out at their town hall meetings and call/e-mail every elected representative they have. If they agree with you, you could write the letter on their behalf and allow them to cut and paste the parts they agree with.
Blue dog listing is below, there are some missing, though, including Gene Taylor from MS district 4.
http://en.wikipedia.org/wiki/Blue_Dog_Coalition#MembersThis bill is bad for Radiologists, Physicians in general, bad for patients, and bad for America. If you disagree, or if you feel that I’m reading this wrong, I’d love to hear your point.
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9 Replies
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Excellent overview. I am only 250 or so pages into this thing right now…so we shall see. But as far as I can tell most of your analysis is spot on.
Additionally, they are still talking bundling of payments…did find a specific provision about that?
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Yes.
Bundling of payments will happen, along with other “modernized approaches to payment”, as deemed appropriate by the Commissioner . Sec 224, pg 125 specifically includes:
Patient centered medical home: a previous section defines this as a capitated health care system with a once-monthly payment to the central provider who may be a “physician or other provider”. This is HMO-type capitation run with gov’t bureaucratic efficiency, apparently allowing NPs to be directly responsible for directing patient care without physician supervision. I assume this is a change from the current system. I think there is a requirement for physician supervision currently, but not sure. Does anyone know?
Accountable care organizations: These are defined as groups of “physicians or other providers” who care for patient groups. Essentially another capitated payment structure.
Value-based purchasing
Bundling of services. Nothing more specific on this. The current ACES trial for Medicare will run for 18 months as a trial for this scheme which is another capitation scheme for inpatient services. Keep in mind that in this model, the more a prosthesis costs, the less pay available for the surgeon and other providers.
performance or utilization based payments, partial capitation, and direct contracting with providers.
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I didn’t take the time to compare this point by point. However, I did compare the page 30 sec 123 portion. Umm, It didn’t ever say anything about coverage being “decided and rationed”. It said recommendations were to be made to the Secretary. It did not say anything about “determining coverage”, but did refer to actuarials that determine premiums paid for coverage. There was also a section requiring public input. As far as the “government bean counter” thing goes, it specifically says that the committee won’t be Federal employees.
The reform process is concerning enough without hysterical misrepresentations. I am pretty sure you are depending on everyone that reads your post to take your words as truth so that your “mission” will be accomplished.
Who are you affiliated with and what is your agenda?
PF could stand for Pants on Fire!!-
ORIGINAL: Justapeon
I didn’t take the time to compare this point by point.
First of all, I admire your approach of “hey, I haven’t expended any time or energy to actually read the bill, but I think I understand it better than you”.
However, I did compare the page 30 sec 123 portion. Umm, It didn’t ever say anything about coverage being “decided and rationed”. It said recommendations were to be made to the Secretary. It did not say anything about “determining coverage”, but did refer to actuarials that determine premiums paid for coverage. There was also a section requiring public input.
Consider this quote from sec 124, (b).
(b) Adoption of Standards-(1) INITIAL STANDARDS- Not later than 18 months after the date of the enactment of this Act, the Secretary shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards.
(2) PERIODIC UPDATING STANDARDS- Under subsection (a), the Secretary shall provide for the periodic updating of the benefit standards previously adopted under this section.
(3) REQUIREMENT- The Secretary may not adopt any benefit standards for an essential benefits package or for level of cost-sharing that are inconsistent with the requirements for such a package or level under sections 122 and 123(b)(5).
As far as the “government bean counter” thing goes, it specifically says that the committee won’t be Federal employees.
I googled “bean counter” and came up with this:
bean counter (bean counters plural ), bean-counter You can describe people such as accountants and business managers as bean counters if you disapprove of them because you think they are only interested in money. n-count
(disapproval) …bean counters who tend to focus on controlling expenses.I think my description of 9 Federal appointees of the Comptroller of the Congressional Budget Office as “bean counters” – accountants/business managers whose interest is in money and the cost of things- is probably pretty accurate.
Not only did you not take the time to read the bill, you didn’t even read my post. I never once said anything about the Committee members being Federal employees. It’s pretty clearly stated that the majority are Federal appointees, except for the 8 who CAN be Federal employees.
The reform process is concerning enough without hysterical misrepresentations. I am pretty sure you are depending on everyone that reads your post to take your words as truth so that your “mission” will be accomplished.
Who are you affiliated with and what is your agenda?
PF could stand for Pants on Fire!!I would ask you, as a starting member with two posts, who YOU are, and what is YOUR agenda? As far as “hysterical misrepresentations”, I think my reading of the bill is sound. I also made it clear that I’d like to hear if someone thinks I’m reading something wrong. That’s the purpose of discussing things. You can’t spend 20 seconds on something like that and expect your opinion to be taken seriously, though.
There have been some changes in the bill, however, and it is something that will continue to be updated, I am sure. And from what I understand, the Senate has yet to release their final version. A bill from one of their committees is available online, but I haven’t had the time to read it.
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By the way, the most up to date version of the bill is on
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200.IH:
The TGR will be separated into 3 components: Most Rad studies are covered by TGR subsection dealing with the S&I codes that will have an allowable growth rate of 1% per year. The AMA states that these TGRs will be reset every 5 years, but I don’t see it.
The AMA says that co-ops were instituted into the bill, but I didn’t see that anywhere. They also say that the physician pay for the public option is no longer tied to Medicare, but it looks to me like it still is, if you read it. It’s 5% more than Medicare, just for the first 3 years.
I realize I’m probably wasting a lot of time on this, but this just bothers me. It seems like this started in 1935, when they asked to start a retirement plan for our grandparents. Of course, they depleted the trust fund and misappropriated the money and now the program is nearly insolvent. Same thing happened in 1965, when they asked to start a retirement health insurance plan for our parents. Of course, the money was misappropriated and now the program is nearly insolvent.
Now, to avoid bankruptcy , they’re asking us to start a new health insurance program. They’ll take a large portion of the American economy under their wing, manage the money, and control costs….. What could go wrong???? Give this 30-40 years, and this could easily be the straw that broke America’s debt-ridden back. That’s the reason I’m opposed to it.
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This is going to be [b][i]really bad[/i][/b] for us. I am anticipating a 50% pay cut. Wow, thanks libs.
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Quote from macrophallus
This is going to be [b][i]really bad[/i][/b] for us. I am anticipating a 50% pay cut. Wow, thanks libs.
Anybody watch the “ACR Live Town Hall: Stop Medicare Cuts” last night?
I watched bits of it. Overall good job in explaining the current issue and strategies that are being used to fight this. Best case scenario something gets passed during lame-duck session-ideally linked with a Covid relief bill which will be the larger issue. I was impressed with the size of non-rad coalition-including GI and neuro-surg (with some specialties being in favor of this change before the final proposed ruling where they are now facing cuts). Also did not realize that this has been a long-standing issue with recent deregulation from Trump giving CMS the green light to move on this. I could be wrong but don’t think this is a partisan issue.-
This thread is 11 years old my friend.
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The level of discourse has really gone downhill on AM in 11 years, looking at COVID threads.
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