Beginning September 2010, the first reforms of the "Patient Protection and Affordable Care Act," (H.R. 3590) will take effect, including insurance reforms that will protect Americans with chronic and costly health conditions. Specifically, insurers offering group or individual health insurance coverage will be prohibited from imposing lifetime limits on coverage and annual limits will be restricted. Insurers will also be prohibited from rescinding coverage and will be required to provide coverage without any cost-sharing requirements of evidence-based items or services that have a rating of "A" or "B", such as colonoscopies, from the U.S. Preventive Services Task Force. Also effective this year, group and individual health insurers offering dependent coverage will be required to allow unmarried individuals until age 26 to remain on their parents' health insurance. Additionally, insurers can not impose pre-existing condition exclusions on children.

 

Physicians will also begin to feel some of the effects of the health reform bill this year. Effective immediately, the current geographic practice cost index (GPCI) floor (1.00) will be extended through 2010, which will benefit providers in rural areas. Additionally, the practice expense GPCI will be adjusted for 2010 to reflect one half of the difference between the relative costs of employee wages and rents in each of the different fee schedule areas and the national averages. Also effective immediately, physicians who practice in free clinics will receive liability protections under the Federal Tort Claims Act.      

 

With enactment of H.R. 3590, the Federal Coordinating Council for Comparative Effectiveness Research established under the American Recovery and Reinvestment Act is terminated and replaced with a new Patient-Centered Outcomes Research Institute, which will be tasked with identifying national priorities for comparative clinical effectiveness research, as well as establishing and carrying out a research project agenda.

 

On March 25, health reform legislation cleared its final hurdle with passage in the House of the "Health Care and Education Reconciliation Act of 2010" (H.R. 4872). H.R. 4872 includes modifications to the health reform bill (H.R. 3590) that became law on March 23. Following initial passage of the Reconciliation bill by the House on March 21, the bill was passed by the Senate but included a modification to a student loan provision, requiring another vote on the bill by the House. The legislation is now headed to the President for his signature. 

 

The ASGE will continue to provide information and analysis on the newly enacted health reform bill through this and other ASGE publications. To learn more about changes resulting from the health reform legislation consider attending Endoscopy in the Future: What Healthcare Reform Means to You, at DDW® on Tuesday, May 4th at 4:15 p.m. in room 273 of the convention center.

 

 

 

On March 15, the ASGE, the American Gastroenterological Association, and the American College of Gastroenterology submitted joint comments to CMS on the proposed rule for the Medicare and Medicaid Electronic Health Record Incentive Program.  CMS received more than 2,700 comments letters and a final rule is not expected until June.

 

The letter included several recommendations, including providing physicians with increased flexibility for achieving meaningful use. The three gastroenterology (GI) societies argued that CMS' proposed 25 measures for meaningful use in 2011 and 2012 were overly complex and burdensome and could actually serve as a deterrent to EHR adoption. The letter also stated that the proposed timeline for clinical quality reporting was too aggressive and recommended that physicians be allowed to satisfy clinical quality reporting by attesting participation in a data registry or established quality reporting program, such as the Physician Quality Reporting Improvement (PQRI) program. The GI societies also asked for CMS to clarify what the meaningful use obligations will be for gastroenterologists who treat patients in the ASC setting since ASCs are not eligible, as an entity, for incentive payments and therefore not expected to maintain a comprehensive certified EHR.

 

The GI societies also submitted comments on the proposed health information technology (HIT) standards issued by the Office of the National Coordinator for HIT.  In addition, the ASGE joined numerous other national and state medical societies in a joint comment letter to CMS, which was spearheaded by the American Medical Association.

 

 

This month the Medicare Payment Advisory Commission (MedPAC) released its annual March report to Congress. MedPAC is an independent congressional agency that advises Congress on issues affecting the Medicare program. In its report, MedPAC recommended that Medicare's payment for physician services should be increased by 1.0 percent in 2011. The report also examines Medicare beneficiary access to care and increases and decreases in service volume. Interestingly, according to the report colonoscopy volume experienced a decrease. For 2003-2007, the average annual rate of growth of colonoscopy use was 1.9 percent, but fell to -1.4 percent for 2007-2008.  MedPAC conceded that the cause of the decrease is difficult to interpret and noted that Medicare beneficiaries use different types of services for screening, diagnosis, and treatment of disease of the colon. The report stated that MedPAC will monitor these services for changes in utilization.

 

For ambulatory surgical centers (ASCs), MedPAC recommends a 0.6 percent increase in payment rates for 2011, concurrent with requiring ASCs to submit cost and quality data. MedPAC recommends a 0.6 percent update even though the consumer price index for urban areas (CPI-U) that CMS has been using to update ASC payments is estimated to be 1.4 percent for 2011. MedPAC defends the 0.6 percent update recommendation by stating that the supply of Medicare-certified ASCs has increased, beneficiaries' use of ASCs has increased, and access to capital has been adequate. MedPAC recommended a 0.6 percent update for 2010, but CMS subsequently provided a 1.2 percent increase. The report states that better ASC cost and quality data is needed to conduct a thorough evaluation of the adequacy of ASC payments.

 

 

Earlier this month, the ASGE joined with more than 100 medical and public health organizations in successfully opposing an amendment offered by Sen. Jeff Sessions (R-AL) and Sen. Claire McCaskill (D-MO) to the Federal Aviation Administration reauthorization bill that would have capped statutory discretionary spending through FY 2013. The amendment was defeated by a vote of 56-40, with four senators not voting. Had the amendment passed, it would have essentially frozen all discretionary spending, negatively impacting research and programs administered through the National Institutes of Health and the Centers for Disease Control and Prevention.

 

 

On March 17 the Colorectal Cancer Coalition (C3), Preventing Colorectal Cancer, and the Prevent Cancer Foundation sponsored a briefing on Capitol Hill in an effort to raise awareness about the importance of colorectal cancer screening and to generate support for H.R. 1189, the "Colorectal Cancer Prevention, Early Detection, and Treatment Act." The briefing provided attendees with information on barriers to better screening rates and the economic return that colorectal cancer screening provides to our health care system. Colorectal Cancer Awareness Month will conclude with a March 30 colorectal cancer congressional call-in day being coordinated by C3 and the Prevent Cancer Foundation. ASGE issued an alert on March 24 encouraging its members to contact their legislators on Tuesday, March 30 in support of legislation designed to reduce the number of preventable deaths from colorectal cancer. 

 

 

On March 16, members of the ASGE Health and Public Policy Committee traveled to Capitol Hill and carried with them messages on several ASGE priority issues, which included increased funding for colorectal cancer screening and digestive disease research, as well as for Medicare payment reform for physicians and ambulatory surgical centers. Additionally that week, ASGE members responded to a call-to-action by faxing to their members of Congress more than 140 letters with fact sheets on ASGE priority issues. ASGE members can still participate in the virtual lobbying day effort. ASGE wants every member of Congress to be reached by this campaign. It is critical that gastroenterologists continue to make their voices heard on Capitol Hill, especially at a time when there is so much at stake for physicians and their patients.