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DJP Update 5-31-2011 A plan to solve America’s fiscal problems – Worth reading – Note removal of restrictions on “balance-billing” in Medicare and the repeal of PPACA or ACA

DJP Update 5-31-2011 A plan to solve America’s fiscal problems – Worth reading – Note removal of restrictions on “balance-billing” in Medicare and the repeal of PPACA or ACA

Fiscal Solutions:

A Balanced Plan for Fiscal Stability and Economic Growth

Joseph Antos, Andrew Biggs, Alex Brill, and Alan D. Viard

May 25, 2011

“This plan was developed as part of the Solutions Initiative and funded by the Peter G. Peterson Foundation.

The Peterson Foundation convened organizations with a variety of perspectives to develop plans addressing our nation’s fiscal challenges. The American Enterprise Institute, Bipartisan Policy Center, Center for American Progress, Economic Policy Institute, The Heritage Foundation, and Roosevelt Institute Campus Network each received grants.”

EXCERPT FROM PAGE 8 OF 28 PAGE REPORT IN THE DISCUSSION OF MEDICARE

Our plan stabilizes physician payment rates and allows them to increase with general inflation. To introduce an element of market pricing, restrictions on “balance billing” would be lifted. Physicians would be permitted to charge any amount over the Medicare payment for their services (subject to their ability to command higher prices in the market), as long as they disclose their prices in advance. In addition, restrictions on physician ability to provide services to Medicare beneficiaries outside of program rules (referred to as “private contracting”) would be lifted.

———

EXCERPT FROM PAGE 3 OF 28 PAGE REPORT IN THE DISCUSSION OF PPACA OR ACA.  RECOMMENDS REPEALING ACA.

To develop an effective plan, it is necessary to repeal the ACA and replace it with a new set of policies based on market principles and budget realities. Nonetheless, the major objectives of that legislation (such as creating an organized marketplace for insurance, better information for consumers, and expanded federal insurance subsidies for those most in need) are reflected in new policies better able to achieve those goals.

DJP Comment:  This is movement in the direction of liberty.  The word is getting out.

The entire report is at:  http://www.kaiserhealthnews.org/~/media/files/2011/aei%202011%20fiscal%20summit.pdf?referrer=search

Thanks to Katie Orrico for the alert about this report.

———-

Finally, thanks for the kind letters about Tabasco!

Stay well.

Donald

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.  With newer operating systems, such as SNOW LEOPARD on Mac, you can put Twitter apps on your notebook or desktop.

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

Also, recent selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2331 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

 

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DJP Update 5-29-2011: R.I.P. Tabasco the dog 1995-2011; Memorial Day 2011; Loss of a friend to all: Former AMA President John L. Clowe, MD

DJP Update 5-29-2011: R.I.P. Tabasco the dog 1995-2011; Memorial Day 2011; Loss of a friend to all: Former AMA President John L. Clowe, MD

R.I.P. Tabasco 1995-2011

Tabasco departed to dog heaven to meet Sacha and Chloe at 11:15 a.m. yesterday (May 28, 2011).  We were with her at the end of her wonderful life on earth.  A loyal and loving dog, we will miss her greatly.

Tabasco was the most amazing dog I ever owned.  Robin and I rescued her from the highway when she was about 6 months of age.  I told Robin it was sad to see the dead dog on the highway.  Robin insisted she could be alive and asked me what was I going to tell the kids about why I did not stop.  I stopped the car and walked out on the highway to confirm the death to satisfy Robin.  To my amazement, the dog lifted her head, looked at me with big eyes that appeared to bugle from her emaciated body.  Her head then collapsed to the road.  Fleas were everywhere and blood surrounded the dog’s head.  With her red coat and nearness to Avery Island, we named her Tabasco.  After intense treatment at a tertiary care Vet hospital, her wounds were on the mend, and her fleas, intestinal worms, and heart worms cured.  She would have been 16 years of age on July 4th (her assigned birthday based on the Vets estimate of age.)  She was a fearless street-wise dog and loved and protected our home.  To her, Robin was the leader of the pack.  Always gently and protective of the grandkids, everyone loved Tabasco.  No large dog ever intimidated her.

——

Photos of Tabasco including a favorite where she is pictured with her two sisters

http://www.donaldpalmisano.com/html/tabasco.html

A photo of Tabasco taking a ride with Robin (scroll down the page and double-click on image of Tabasco to enlarge)

http://twitpic.com/photos/DJPNEWS?page=2

The Story of Tabasco is told in this issue of The Pelican Brief in 1996

http://www.donaldpalmisano.com/html/ama1.html#tabasco

Note the photo caption accompanying The Pelican Brief.  An interesting reminder:

Dr. Palmisano questions Dr. Bill Frist,
U.S. Senator from Tennessee, at the
1995 AMA Grassroots Conference in Washington, DC about whether the proposed Medicare reforms include the right to privately contract (AMA Policy 165.916).

———-

MEMORIAL DAY 2011

Let us give thanks for those who gave their lives for liberty.  Freedom in not Free.

http://twitpic.com/photos/DJPNEWS?page=2 (Scroll down page and double-click on photo of “Freedom is Not Free” Memorial Day image to enlarge.)

More on the concept of “Freedom is not Free” in epilogue of my book “ON LEADERSHIP”.

See this excerpt from book.  Go to bottom of page:  http://onleadership.us/pages/excerpts.php

——-

LOSS OF A FRIEND TO ALL:  Former AMA President John L. Clowe, MD

AMA sent this message to all of the AMA former presidents and chairs:

It is with regret that I inform you that we have received word that former AMA President John L. Clowe, MD, passed away Wednesday at the age of 89.  Dr. Clowe served as AMA President in 1992-1993.  Prior to being elected president, he served as Speaker (1987-1991) and Vice Speaker (1984-1987) of the House of Delegates.  He was also a former president and speaker of the Medical Society of the State of New York, and a charter fellow and member of the American Academy of Family Physicians.

A family physician from Schenectady, New York, Dr. Clowe retired to Englewood, Florida with his beloved wife Marion many years ago.  In addition to his many accomplishments as a physician, Dr. Clowe was a fine man, as well as a good husband and father, and we will miss his gentility, grace, and gentle sense of humor.

——–

Many fine tributes to Dr. Clowe were sent to AMA by the past presidents and chairs regarding Dr. Clowe.  Here is what I sent:

Dr. Clowe truly was a gentle man and a gentleman.  He always greeted Robin & me with a smile and had an amazing memory for first names.  His comments at the microphone in the years after his presidency were insightful and full of practical wisdom.

May he rest in peace and his memory live on.  Our sincere condolences.

——–

Note: AMA will soon have funeral arrangement information available.  It would be nice for AMA to put a notice on AMA home page about the passing of this wonderful doctor who served as AMA President and Speaker.  I can’t find any mention as of today on Website.

———

Stay well!  And hug a loved one this weekend.  Everyone appreciates a hug especially in times of loss.

Donald

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.  With newer operating systems, such as SNOW LEOPARD on Mac, you can put Twitter apps on your notebook or desktop.

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

Also, recent selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

 

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2331 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

 

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DJP UPDATE 5-21-2011 Great trip to NYC for TV interview and more; AMA and multiple medical & specialty societies sign on for support of balance-billing in Medicare; MAG; LAGNIAPPE

DJP UPDATE 5-21-2011 Great trip to NYC for TV interview and more;  AMA and multiple medical & specialty societies sign on for support of balance-billing in Medicare; MAG; LAGNIAPPE

Robin and I had a great trip to New York City.  TV interview, a meeting with Philip Howard of Common Good (one of the most creative persons I know), a visit to my publisher, Skyhorse Publishing (who just bought another company and moved to new headquarters!), and dinner with a client of Intrepid Resources who has become a dear friend over many years of association.  And Robin even figured how to get in an afternoon Broadway play even though she attended all of the activities I attended.  She is full of energy and loves NYC.  I missed the play.
The in-studio interview on Fox and Friends in New York City took place May 18. I was the first person interviewed that day on the show.  It went very well.  A giant copy of the book was evident in the background during the interview.
Also the book was shown by itself on the screen.  If you did not have time to see the interview, you can see it online at YouTube at my IntrepidResources site.  Segment only takes 4 minutes and 5 seconds to view.
and click on May 18, 2011 interview
OR
go to:
Parts of the interview were shown over and over again during other hours of the show.  The hot issue:  waivers given to the PPACA law and the high percentage in former speaker’s district.
Also, my book made the top of the Fox & Friends Reading List

Fox & Friends Reading List

  • ‘On Leadership’
    unknown.jpgFrom the publisher
    Leadership is a skill that can be taught, especially through the study of exemplary figures of the past. In each chapter of ‘On Leadership,’ Dr. Donald J. Palmisano cites an example of positive or negative action as a source from which to glean essential leadership lessons |Click here to learn more
——
Thanks to all who have written me about their purchase of multiple copies of book to give as gifts.  I wish everyone in Congress could read the book because the last two chapters (the new chapters) give a powerful message from the majority of Americans. If only Congress would listen before the USA goes bankrupt and also destroys innovation, incentive, and access to care.  Some on the list may not like these thoughts as they wish to continue full speed ahead in the direction we are going now but it would be a sad state of affairs if we sat silently by and did not voice opinions on how to preserve the liberty that we enjoyed because of others dying to protect our freedoms.  Yes, and Happy Armed Forces Day! Thank a veteran and those currently in the military. I honor them always by wearing my JCOC63 pin that you see on my coat in the TV video above.
——
ITEM TWO:  Balance Billing
http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/practice-management/balance-billing.page?

Balance Billing

2009 letter from AMA

Under Medicare, certain physicians may opt to bill patients a portion of what Medicare does not cover for medical services. This is called “balance billing” but Medicare strictly limits how much physicians may balance bill their patients. Many private payers also restrict or prohibit physicians from balance billing their patients.

Representative Tom Price (R-GA-6) has sponsored a bill, H.R. 1384, supporting the AMA’s stance on balance billing.

Letter to Rep Price supporting his introduction of HR 1384 balance billing legislation March 18, 2009

——

May 5, 2011 Letter from AMA

http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/practice-management/medicare-patient-empowerment-act.page?

Medicare Patient Empowerment Act

Rep. Tom Price, MD (R-GA) introduced H.R. 1700, the Medicare Patient Empowerment Act, on May 3, 2011
(see summary). This bill, in line with AMA policy, would allow Medicare patients and their physicians to enter into private contracts without penalty to either party. It would enable beneficiaries to use their Medicare benefits to see physicians who do not accept Medicare, as opposed to paying for the entire cost of their care out-of-pocket as required under current law.

—-

Thanks to those who have advocated this important liberty right over the years and AMA explicit policy since 1993.  And special thanks to those, such as the Coalition of State Medical and National Specialty Societies who have refused to let this critical issue be forgotten.
See this link:  http://www.mag.org/pdfs/pr_williamson_testimony_050511.pdf
This Coalition testimony left no doubt what the message was.  It was stated in the oral testimony, not hidden in the printed submission.  Good example of FOCUS!

A point never to forget: Dr. Williamson told the subcommittee – which includes MAG member and Georgia Rep. Phil Gingrey, M.D. – that the government has the right to determine what it will pay toward medical care, but it doesn’t have the right to determine the value of that medical care. “This value determination should ultimately be made by the individual patient,” he pronounced.
(DJP Comment: That is consistent with LIBERTY!)

The Coalition of State Medical and National Specialty Societies is made up of 16 member groups that 

represent some 90,000 physicians. With some 6,000 members, MAG is the leading voice for the medical

profession in Georgia. Go to www.mag.org for more information.

In my view, the AMA Website should have this issue in BOLD print on the home page of AMA in addition to doing a powerful ad campaign on radio and TV.  Republicans and Democrats need to pay attention to this important issue.  Price-fixing will continue to decrease access to care.  Then the doctors will be blamed.
The AMA June meeting, as always, will be interesting.  In the near future we will witness a resurgence of activism or, alternatively,  a dying profession, strangled by government.  The future is in our hands.  Will future generations say doctors just groused around the coffee pot, or went along to get along, or remembered the honored traditions of Medicine and fought bravely to prevent encroachment on the ethical science-based practice of Medicine?  Time will tell and it won’t be a long time from now.
—-
And a tip of the hat to Medical Association of Georgia.  A job well done!
http://capwiz.com/mag/issues/alert/?alertid=46367501&queueid=%5bcapwiz:queue_id%5d

05.12 Gov. Deal signs prompt pay bill into law

Gov. Nathan Deal has signed the “prompt pay” bill (H.B. 167) into law. The measure will require third party administrators to pay paper claims in 30 days and electronic claims in 15 days, respectively, or address why they haven’t done so.”Our sincere thanks to Governor Deal for his vision and leadership,” MAG President Dan DeLoach, M.D., said of the development. “This is going to enhance the practice environment and access to care in the state.”

——–

Off to Washington, DC area on Monday for patient safety meetings:  Board of Governors NPSF and Annual Congress!  Plane travel with all of the screening and exposure to X-Rays  wears a person out!  Meanwhile, the majority of the Southern border is porous.

—–

LAGNIAPPE: Check out this quick photo I took with the iPhone as the plane approached NYC and I noted the Empire State Bldg piercing the clouds.  STANDING TALL!  Double click on image to enlarge it.

http://twitpic.com/photos/DJPNEWS

Stay well and hug a loved one!  Everyone loves to be appreciated.

Donald

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.  With newer operating systems, such as SNOW LEOPARD on Mac, you can put Twitter apps on your notebook or desktop.

Leave a comment and encourage others to visit!
Also, recent selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/
Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
This DJP Update goes to 2331 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.

 

 

 

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DJP Update 5-16-2011 Media Alert – DJP will be on Fox & Friends in NYC Wednesday 5-18 at 8:15 a.m. Eastern; Some tweets; LAGNIAPPE

DJP Update 5-16-2011 Media Alert – DJP will be on Fox & Friends in NYC Wednesday 5-18 at 8:15 a.m. Eastern; Some tweets; LAGNIAPPE for car lovers

Fox and Friends now have a copy of the 2nd edition of my book, ON LEADERSHIP, expanded with two new chapters on current events.  I am invited to fly to New York City and appear on TV in studio on a political panel. Tune in or record if you can at 8:15 a.m. Eastern Time this Wednesday, May 18, 2011.

Here is a link containing remarks by the Prime Minister in Great Britain about the NHS:  http://bit.ly/jWPQz4

You will note that problems exist there.  Wish those in Washington, DC would learn why top-down control ultimately fails.

Below are some tweets I did about his comments; posted at www.twitter.com/DJPNEWS

—–

unknown.png

DJPNEWS Donald Palmisano

@WhiteHouse @Senate_GOPs @SenateDems re #PPACA #hcr http://bit.ly/jWPQz4 one can learn from failed experiments

6 hours ago

unknown.png

DJPNEWS Donald Palmisano

Prime Minister: #NHS “too much top-down control” – candor nice; Dx correct; but wrong conclusion. http://bit.ly/jWPQz4 #hcr #tcot #PPACA

6 hours ago

 

unknown.png

DJPNEWS Donald Palmisano

Gov med; #hcr #tcot RT @Number10gov: “Sticking with..status quo is not an option”. ..David Cameron’s speech on the NHS http://bit.ly/jWPQz4

7 hours ago

——

LAGNIAPPE: For car lovers, go to http://twitpic.com/photos/DJPNEWS and see an awesome 2012 Mustang GT Premium with 5.0 Coyote engine  (last 3 images posted).  My 15-year-old car is being moved to the side for its replacement.  Awesome car.

Appreciate the book purchases!  Now is the time to get the orders in to Amazon, etc. for the ratings.

Stay well.

Donald

P.S. Stop by http://twitter.com/DJPNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates.  Twitter is free and takes minutes to join.  Put email in and pick password.  Great source of breaking news and you don’t flood your email with it.  You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.  With newer operating systems, such as SNOW LEOPARD on Mac, you can put Twitter apps on your notebook or desktop.

Go to:  http://www.youtube.com/user/IntrepidResources

Leave a comment and encourage others to visit!

Also, recent selected DJP Updates can be found at: http://donaldpalmisano.com/djp_update/

Donald J. Palmisano, MD, JD

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

504-455-9392 fax

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

DJP Updates:  http://donaldpalmisano.com/djp_update/

Twitter:  www.twitter.com/DJPNEWS

YouTube:  http://www.youtube.com/user/IntrepidResources

This DJP Update goes to 2331 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an  email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

 

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DJP Update 5-5-2011 Congressional hearing today on the SGR mess: a leader emerges; LAGNIAPPE

DJP Update 5-5-2011 Congressional hearing today on the SGR mess: a leader emerges; LAGNIAPPE

House Energy and Commerce Committee Health Subcommittee held a hearing on alternatives to the SGR Thursday, May 5 at 10:00 am Eastern

A young warrior physician leader has emerged.   Dr. M. Todd Williamson, a Georgia neurologist, gives the answer to  the broken SGR mess.  The answer is long-standing AMA policy, namely, the right to balance-bill without penalty any fee agreed upon by patient and physician, regardless what government pays in Medicare.  He represented over 90,000 physicians whose organizations below to the Coalition of State Medical and National Specialty Societies.  All of these organizations sit in the AMA House of Delegates.  Also 3 former AMA presidents Drs Johnson, Palmisano, & Plested, are non-voting honorary members of this Coalition.

This is the answer to the SGR mess.  Don’t advocate for longer chains.  Cut the chains and restore liberty.  That ends the problem of finding a doctor.  The evolving access to care crisis will end.

—–

Here is Dr. Williamson’s testimony:

http://mag.org/pdfs/williamson_testimony_050511.pdf

NOTE the 3 points in this EXCERPT from the testimony:

The Coalition of State Medical and National Specialty Societies is therefore convinced that the key to preserving our Medicare patients’ access to quality medical care is overhauling the flawed Medicare payment system, and to address the problem, Congress should include the Medicare Patient Empowerment Act as an essential part of any Medicare reform.  This legislation would:

–Establish a new Medicare payment option whereby patients and physicians would be free to contract for medical care without penalty;

–Allow these patients to apply their Medicare benefits to the physician of their choice and to contract for any amount not covered by Medicare; and

–Physicians would be free to opt in or out of Medicare on a per-patient basis, while patients could pay for their care as they see fit and be reimbursed for an amount equal to that paid to “participating” Medicare physicians.

——

Here are some articles about the testimony and other comments.  (Thanks to Katie Orrico for sending 3 of these articles to me.)

From the BNA Health Care Daily

Private Contracting, Bundling Among Ideas Offered to Fix Physician Payment System

Private contracting and bundling were among an array of ideas presented by witnesses before a House subcommittee hearing May 5 as possible methods to reform the Medicare physician payment system.

“Although we cannot afford the current rate of spending on physician services, we also know that, if the pending 29.4 percent fee cuts are allowed to go into effect, a large number of doctors will be forced out of Medicare and a large number of Medicare beneficiaries will lose access to care,” House Energy and Commerce Chairman Fred Upton (R-Mich.) told the hearing.

The Subcommittee on Health hearing was intended to examine potential models to reimburse physicians for Medicare services that focus on “value and quality.”

Crafting a solution to the situation, in which the sustainable growth rate (SGR) formula has led to substantial cuts for almost the entire decade—and will lead to the nearly 30 percent cut as of Jan. 1, 2012—is on the committee’s “short list” this summer, Upton said.

However, just offering doctors the same amount that they are current receiving through 2020 will cost $275.8 billion, according to a committee memorandum that cites the Congressional

Budget Office.

Bipartisan Effort

Recognizing the bipartisan effort, subcommittee Chairman Joe Pitts (R-Pa.) said that “all of us agree on the need for a new payment system and there are a lot of good ideas about what an ideal payment system should look like.”

The committee has “taken a big step today in moving beyond previous discussions of the deficiencies of the sustainable growth rate system to an examination of the payment delivery system that we need and how to get there,” Pitts said.

Full committee ranking member Henry A. Waxman (D-Calif.) said that just filling in the payment gap created by the SGR is inadequate. “We must work toward a new way of paying for care, for physicians and all providers, that encourages integrated care.”

However, Waxman cautioned members not to shift SGR payment problems onto beneficiaries.

He referred to letters sent May 4 to the committee from AARP and the Medicare Rights Center opposing proposals “that would increase cost sharing under the guise of ‘private contracting.’”

The subcommittee heard from five physicians on a witness panel of seven who offered ideas for replacing the SGR, as well as changing the current fee-for-service system that is said to reward service volume rather than quality.

Private Contracting

Representing the Coalition of State Medical and National Specialty Societies, M. Todd Williamson said his group supports a bill (H.R. 1700), introduced May 3, that would establish a Medicare payment option for patients and practitioners to contract for Medicare fee-for-service items and services.

The bill would allow patients to apply their Medicare benefits to the physician of their choice and to contract for any amount not covered by Medicare.

“Physicians would be free to opt in or out of Medicare on a per-patient basis, while patients could pay for their care as they see fit and be reimbursed for an amount equal to that paid to participating Medicare physicians,” according to Williamson, a neurologist from Atlanta.

Medicare should pay its share of the charge and allow the patient to pay the balance, according to his testimony. “It is reprehensible for a physician to be subject to civil and criminal penalties if he or she doesn’t collect a patient’s copayment, as is now the case.”

In their letters, both the AARP and the Medicare Rights Center objected to the proposal.

“AARP strongly opposes relaxing the current Medicare rules related to balance billing and/or private contracting because they would do nothing more than shift costs onto Medicare beneficiaries,” Nancy LeaMond, an AARP executive vice president, said.

“Not only do private contracting and balance billing shift costs onto beneficiaries, but neither does anything to improve the quality of care delivered,” she said. “While this may provide more fiscal certainty to the federal government, it would produce tremendous financial insecurity among those on Medicare, who would have no limits on what their doctors could charge them.”

Similarly, Joe Baker, president of the consumer organization Medicare Rights Center, expressed “grave concerns” about allowing physicians to enter into contracts with beneficiaries and “balance bill” them for cost sharing.

He said that “out-of-pocket spending for Medicare patients is already burdensome and increased from 11.8 percent in 1998 to 16.2 percent in 2006.”

Baker said that such a proposal would “serve to fundamentally undermine the purpose of the Medicare program by unraveling the protections against high costs that prevent people from accessing the care they require” and could spread to other providers, such as hospitals.

Invitation to Associations

The hearing came after the committee invited physician groups to offer ideas about reworking the system.

In his testimony, American Medical Association President Cecil B. Wilson emphasized his organization’s three-prong approach of repealing the SGR, implementing a five-year period of stable payments, and transitioning to choices of new payment models.

The choices could include gainsharing, in which groups of providers work together to manage care and are eligible to share in any cost savings, and payment bundling programs across providers and episodes of care, he said.

Meanwhile, the AMA and specialty and state medical societies have formed a Physician Innovator Committee for those who are participating in payment and delivery innovations to share expertise and resources, Wilson said.

“The Leadership Group can allow the physician community to begin immediately to develop the knowledge base on the next generation of physician payment models and not have to solely rely on formal evaluation studies whenever they are issued by the government,” Wilson said.

Bundled Payments

Michael Chernew, a professor of health care policy, Harvard Medical School, spoke in favor of a bundled payment system, rather than fee-for-service.

“A more bundled system that pays for an episode of care or provides a global budget can allow more flexibility for providers and obviate the need for purchasers—such as Medicare or private insurers—to micromanage payment systems,” according to Chernew, a member of the Medicare Payment Advisory Commission, who said he was speaking for himself.

“Moreover, such a bundled system can facilitate cost containment strategies that avoid slashing per unit price when volume rises, as the SGR does,” he said.

Chernew offered as an example the Alternative Quality Contract, implemented by Blue Cross Blue Shield of Massachusetts as part of one of its health maintenance organizations. The system uses a global payment rate in which a provider system receives a budget to cover the costs of providing all of an enrollee’s care.

Former Centers for Medicare & Medicaid Services Administrator Mark McClellan also spoke in favor of bundled payments.

“Under way in several cities right now, Medicare’s Acute Care Episode demonstration pays hospitals and physicians a prospectively fixed amount for a bundle of services that includes both Medicare Part A and Part B, for selected inpatient orthopedic and cardiac procedures,” McClellan, director of the Engelberg Center at the Brookings Institution, said.

“Formal evaluation of the ACE project is not yet complete, but sites are observing significant reductions in episode costs while maintaining or improving quality,” he said.

Democratic committee members urged re-examination of a bill (H.R. 3961) passed by the House in 2009 that would have reformed the system through separate target growth rates and conversion factor updates for two categories of service: evaluation, management, and preventive services; and all other services.

Asked by former committee Chairman John Dingell (D-Mich.) about the possible impact of his legislation, the witnesses unanimously agreed that if H.R. 3961 had been signed into law, doctors would not be facing a 29.4 percent cut in reimbursements in January 2012.

Another subcommittee—the House Ways and Means Subcommittee on Health—is scheduled to hold a hearing on same topic May 12.

—–

CQ TODAY ONLINE NEWS – HEALTH

May 5, 2011 – 4:35 p.m.

Will May Be There for ‘Doc Fix,’ But Not the Money Yet

By Emily Ethridge, CQ Staff

The first committee hearing of the year on fixing the Medicare physician payment system yielded no shortage of ideas — except how to pay for it.

House members of both parties say they are committed to bringing legislation to fix the long-troubled system to the floor by fall. But a House Energy and Commerce subcommittee hearing Thursday demonstrated the difficulty of coming to terms with the huge price tag any permanent solution would carry, especially during a period of growing fiscal austerity.

Lawmakers and witnesses largely sidestepped the question of how to pay for a fix, something that tripped up negotiations on even short-term patches last year. Congress acted five times to stop the cuts in reimbursement rates in 2010, ultimately enacting a one-year patch in December. But when that runs out on Jan. 1, 2012, Medicare officials say, payments will drop by 29.4 percent.

Any solution will cost hundreds of billions of dollars. Simply maintaining the current system, without any updates to the payment rate, would cost $275.8 billion through 2020, said Health Subcommittee Chairman Joe Pitts, Pa.

Provider groups at the hearing emphasized that the problem with the payment formula, known as the sustainable growth rate (SGR), would only grow more expensive with time.

“The SGR is a failed formula. The longer we wait to cast it aside, the deeper a hole we dig,” said American Medical Association President Cecil B. Wilson.

Energy and Commerce Committee Chairman Fred Upton agreed, saying a lack of action would threaten Medicare beneficiaries. He added that finding a solution would be on the committee’s “short list” of legislation to take up this summer.

“Although we cannot afford the current rate of spending on physician services, we also know that if the pending 29.4 percent fee cuts are allowed to go into effect, a large numbers of doctors will be forced out of Medicare and a large number of Medicare beneficiaries will lose access to care,” said Upton, R-Mich.

SOME CONSENSUS

Despite the challenges, Pitts sounded an upbeat note, “I think we’ve taken a big step today . . . to an examination of the kind of delivery system we need and how to get there.”

At the hearing, the medical specialty groups testifying offered similar plans: repeal the SGR, enact a series of stable payments for a five-year period and use that time to do several demonstration projects aimed at finding and enacting a new payment method.

Rep. Bill Cassidy, R-La., questioned where the money to enact such changes would come from, criticizing the Democrats’ health care overhaul law (PL 111-148PL 111-152) for using savings in the Medicare program for purposes other than fixing the payment formula.

“Now that the savings from Medicare have been used outside of Medicare, how will we pay for this?” Cassidy asked.

The groups’ proposals came in response to a bipartisan request last March for ideas from medical organizations.

Several witnesses also voiced support for a measure (HR 1700) introduced this week by Rep. Tom Price, R-Ga., that would allow Medicare beneficiaries to contract with physicians and pay them out of their own pockets, outside of the traditional Medicare payment schedule.

Wilson said the legislation would give beneficiaries more choice in providers, increase the number of physicians who accept Medicare patients and help maintain the Medicare program.

Todd Williamson, a Georgia neurologist and spokesman for the Coalition of State Medical and National Specialty Societies, agreed and said the bill should be included along with other fixes to the physician payment system.

“Every physician will become accessible to every Medicare patient,” if the bill becomes law, said Williamson in a summary of his remarks to the committee. “Private contracting is a key principle of American freedom and liberty.”

But AARP, which did not have a representative testify at the hearing, opposes Price’s bill, saying it would essentially shift costs to beneficiaries.

“AARP strongly opposes the idea of allowing physicians to charge beneficiaries whatever they want, which would essentially pass much of the $330 billion cost directly on to Medicare beneficiaries,” AARP Executive Vice President Nancy LeaMond wrote in a letter to the committee, referring to the estimated cost of fixing the system over 10 years.

A ‘FIXABLE PROBLEM’

Despite the differences in opinion, members emphasized they felt a solution this year was possible.

“It is a fixable problem if we really mean it when Mr. [John D.] Dingell, Mr. [Frank] Pallone [Jr.] and Mr. [Henry A.] Waxman say the same general things as Mr. Upton and Mr. Pitts and people like myself,” said Joe L. Barton, R-Texas, referring to committee members who made the request for proposals in March.

But the best summary of the obstacles ahead may have come at a Health Affairs breakfast Thursday, where Ways and Means Chairman Dave Camp, R-Mich., said he would take up the physician payment issue in his committee, whose Health subcommittee has scheduled a hearing for May 12. Camp added that he wanted a fix that would last several years to buy time for a more permanent solution.

When Camp was asked about how to pay for it, a staff member interrupted and joked there would be a suggestion box at the back of the room.

Joanne Kenen contributed to this story.

—–

CQ HEALTHBEAT NEWS

May 5, 2011 – 4:59 p.m.

New Era May Be Dawning of Testing Doc Pay Methods

By John Reichard, CQ HealthBeat Editor

While a House subcommittee hearing Thursday morning yielded no clues in the unending mystery over how Congress will fund an overhaul of the Medicare physician payment system, it did reveal a consensus among physician groups that a five-year period of experimentation is needed to test new ways to pay doctors.

Republicans and Democrats at the Energy and Commerce Health Subcommittee hearing appeared interested in accommodating the groups.

American Medical Association President Cecil B. Wilson urged lawmakers to follow a three-pronged approach: replace the current sustainable growth rate (SGR) payment system that has doctors expecting a 29.5 percent payment cut Jan. 1; move into a five-year period of stable Medicare payments; and use that time to test and begin adopting “new payment models that reward physicians and hospitals for keeping patients healthy and managing chronic conditions.”

Physician groups generally appear to be on board with that approach.

Harold D. Miller of the Center for Healthcare Quality and Payment Reform outlined basic ways in which payments could be changed to lower costs without rationing and to improve the quality of care. The center includes a number of leading policy analysts, health care foundations, and health care systems.

“One is to keep people well,” Miller said, “so that they don’t have costs at all; second is that if they do have something like a chronic disease, to help them manage that in a way that avoids them having to be hospitalized, and if they do have to be hospitalized to make sure that they don’t get infections, complications and re-admissions. And all of those things save money, but they also are improvements for patients and I think that patients would find desirable.”

But “the current payment system goes in exactly the opposite direction,” he continued. “Doctors and hospitals lose money whenever they prevent infections. We don’t pay for things that help patients stay out of the hospital, and in health care nobody gets paid at all if they stay well.”

You can’t fix those problems by changing fee levels or adding regulations, you do it by “putting in fundamentally different payment models,” Miller said.

Two fundamental changes are needed, he added. The first “is to pay for care on an episode basis rather than on a service-by-service basis, such as having a single price for all of the care associated with an episode” of care such as a heart attack; and also including a “warranty” so that no charges are made by providers when infections or complications occur.

“This is the same way that every other industry in America charges for its products and services — a single price with a warranty,” Miller said.

The other approach, he said, is “comprehensive care payment, which is to have a single payment for a physician practice for all of the care that a patient needs to manage the particular conditions that they have, and in that way provides the flexibility for physicians to decide exactly what the right way is for care to be delivered to that patient.

“Where these programs have been tried they have worked,” he said. Small physician practices can be “the innovators in this if we provide the right kind of support.”

Lawmakers such as Rep. Michael C. Burgess, R-Texas urged that doctors play a leadership role in retooling physician payment, and witnesses agreed.

Former Centers for Medicare and Medicaid Services Administrator Mark McClellan said, “No one knows better than physicians how to answer the key questions: Where are the best opportunities to improve care and avoid unnecessary costs for their Medicare patients, and how can we implement practical payment reforms that support these improvements in care?”

Doctors see opportunities every day to improve the value of care,” he said, “but are frustrated by a Medicare payment system that often works against them.”

For example, McClellan said, oncologists focus on chemotherapy because that is what generates Medicare reimbursement. But they “get little support for doing many of the things that their patients need, things like spending time working out a treatment plan that meets each patient’s individual needs; managing patient symptoms; and coordinating care with other providers.”

Harvard Medical School Professor Michael Chernew described the “alternative quality contract” (AQC) implemented by Blue Cross Blue Shield of Massachusetts as a promising approach. Used in the insurer’s HMO model, it consists of a five-year contract with a physician group that agrees to provide all of the enrollee’s care. To prevent the provider from stinting on care, the AQC varies payment substantially based on quality of care assessed by 64 different measures.

M. Todd Williamson of the Coalition of State Medical and National Specialty Societies urged legislation (HR 1700) that would give doctors the option of contracting privately with Medicare patients to provide care. That approach appears to be of particular interest to the GOP Doctors Caucus in the House.

The measure would allow patients “to apply their Medicare benefits to the physician of their choice and to contract for any amount not covered by Medicare,” he testified. “Physicians would be free to opt in or out of Medicare on a per-patient basis, while patients could pay for their care as they see fit and be reimbursed for an amount equal to that paid to ‘participating’ Medicare physicians” — those who agree to accept the Medicare reimbursement rate as payment in full.

Private contracting has been controversial in the past, arousing concern that lower income Medicare patients would lose access to care.

Of course having a period of experimentation hinges on finding huge sums of “pay-fors” to put off cuts required under the current SGR payment formula. For now, Republicans and Democrats appear intent on postponing the fight over how to do that while seeking agreement on the details of policy to replace the SGR.

John Reichard can be reached at jreichard.com

—–

http://www.medpagetoday.com/PublicHealthPolicy/Medicare/26311

Also a video at this link.  Watch it and see Dr. Cecil Wilson, President of AMA give AMA’s 3 points regarding fixing SGR.  Unfortunately, no mention of private contracting & balance-billing, strong AMA policy.

SGR Reform Looks Closer than Ever
By Emily P. Walker, Washington Correspondent, MedPage Today 

Published: May 05, 2011

 

WASHINGTON — Republicans and Democrats on the House Energy and Commerce Subcommittee on Health were in rare unanimous agreement Thursday during a hearing on the Medicare sustainable growth rate (SGR) payment formula.

“Let’s all accept the premise that SGR has to go,” said Republican Rep. Michael Burgess, MD, of Texas. “We need a permanent solution that is reasonable, updatable, and only that will do.”

The formula used to determine how Medicare reimburses physicians needs to go, agreed members of Congress and witnesses at the hearing. And it needs to be replaced with a fair payment method that covers what it costs to treat Medicare patients, but also gives the physicians a little profit.

The SGR formula ties physician reimbursement to the gross domestic product; it has called for cuts in pay every year since 2002. Both sides have agreed for years that the formula needs to be changed, and, still, Congress is constantly rushing to stave off cuts at the last minute that would make huge slashes to what doctors are paid by Medicare.

At the 11th hour, a stopgap bill always passes, holding steady the fees that Medicare pays doctors for treating the sick and elderly. Then the debate resumes again, and another stopgap eventually passes.

So if there is so much agreement that SGR needs to go, why has no comprehensive, bipartisan bill passed?

Time on the legislative calendar has always run down before tackling a broader Medicare payment bill, Burgess told MedPage Today following the hearing. But this time, if the Energy and Commerce Committee approves SGR reform legislation in June, perhaps the bill could actually pass the full Congress before August recess, Burgess said.

A number members of Congress and witnesses at the hearing — five out of seven of whom were doctors — said Thursday that the time may be more ripe than ever for reforming the SGR system given the current focus on reining in Medicare spending.

One witness, Cecil Wilson, MD, president of the American Medical Association (AMA), called for replacing the SGR with a five-year period of stable Medicare physician payments that keep pace with the growth of medical practices. Eventually, Medicare should transition to “an array of new payment models to enhance care coordination, quality, appropriateness, and costs.”

President Obama signed a short-term fix in December staving off the cuts through 2011. But once that bill expires on the first day of 2012, physicians are expected to face a cut in their Medicare reimbursements of nearly 30%.

Former CMS Administrator Mark McClellan, MD, PhD, told members of Congress not to just readjust the SGR when the law expires in 2012.

“As Congress considers how to address the SGR problem this time around, I urge the subcommittee to look beyond approaches that remain tied to the existing formula simply by delaying it again, or by resetting baselines to higher spending levels,” he said. “Rather, this is an opportunity to provide better support to physicians who lead in improving care.”

Panelists and members of Congress all agreed the traditional fee-for-service model needs to be abolished.

“This dilemma touches on the fundamental problem with fee-for-service — i.e., payment is based solely on what procedure is provided to the patient, not the value of the service provided, and thus encourages volume growth,” said Roland Goertz, MD, president of the American Academy of Family Physicians.

The panel of witnesses told members of Congress it would like to see the SGR scrapped and payments held steady for five years while various new payment models are tested out, including accountable care organizations. Ultimately, physicians and hospitals should be able to choose the payment model that best suits them, Wilson told MedPage Today.

Everyone at the hearing said it’s crucial that physicians have the main leadership role in bringing about changes in payment, and not insurance companies, hospitals, or the government.

While there is widespread agreement on dislike of the SGR, that’s not to say there are no bipartisan disagreements over reforming how doctors are paid under Medicare.

One major disagreement — which strikes at the core of the Medicare program — is that Republicans would like doctors to be able to negotiate payments with Medicare patients. So a wealthy patient could technically pay more than the Medicare rate, or not use their Medicare benefit at all and pay out-of-pocket.

It could go the other way, too, where a doctor could accept a payment of less than the Medicare rate, or a freshly baked pie even, as payment for medical treatment.

Currently, if doctors accept something other than the Medicare rate from their Medicare patients, they could face fines and even criminal prosecution.

Getting a far-reaching Medicare payment reform bill through both chambers of Congress may again prove elusive, but Burgess said he’s holding out hope that maybe this will be the year when Congress can finally stop racing against the clock to block cuts, only to have to face the issue again several months later.

——

http://www.modernhealthcare.com/article/20110505/NEWS/305059972

MODERN HEALTHCARE ARTICLE

Doc-pay solution a high priority: Upton

By Jessica Zigmond

Posted: May 5, 2011 – 3:00 pm ET

Addressing the Medicare physician payment system is on the House Energy and Commerce Committee’s “short list of getting things done this summer,” the panel’s chairman said today during a congressional hearing on the issue.

“Although we cannot afford the current rate of spending on physician services, we also know that, if the pending 29.4% fee cuts are allowed to go into effect, a large good number of doctors will be forced out of Medicare and a large number of Medicare beneficiaries will lose their access to care,” Chairman Fred Upton (R-Mich.) said in his opening remarks during a health subcommittee hearing.

House members from both parties said they are eager to find a solution to Medicare’s current system to pay physicians for their services. They heard about a wide range of potential solutions from a seven-member panel, including former CMS Administrator Dr. Mark McClellan and current AMA President Cecil Wilson, who outlined the AMA’s three-part approach to fixing the system. Wilson said he thinks there is consensus among physician groups, and that consensus includes repealing the sustainable growth-rate formula, implementing a period of stable physician payments, and exploring options on how to structure and pay for care. On the latter, Wilson said a “one-size-fits-all” approach won’t work.

“You’ve got to adjust it to differences in geography, it’s a big country,” Wilson said after the hearing, “differences in culture, and, particularly from the standpoint of physicians and health practitioners, differences in models of care that are different in different parts of the country.”

——-

FINALLY, read AMA press release on this issue:

http://www.ama-assn.org/ama/pub/news/news/ama-president-testifies-medicare-payment.page?

AMA President Testifies Before Congress, Urges Medicare Physician Payment Reforms

Recommends three-pronged approach to reform the physician payment system

For immediate release:
May 5, 2011

WASHINGTON – Today, American Medical Association (AMA) President Cecil B. Wilson, M.D., testifiedico-pdf.png before the House Energy and Commerce Health Subcommittee, urging Congressional leaders to reform the deeply flawed Medicare physician payment formula, also known as the Sustainable Growth Rate (SGR). This formula will trigger a drastic cut of nearly 30 percent on January 1.

“The SGR is a failed formula,” said Dr. Wilson. “The longer we wait to cast it aside, the deeper the hole we dig. It is past time to replace the SGR with a policy that preserves access, promotes quality and increases efficiency.”

In his testimony, Dr. Wilson recommended a three-pronged approach to reforming the physician payment system. This approach includes repealing the SGR, implementing a five-year period of stable Medicare physician payments, and laying the pathway for a new payment system.

During the five-year period, a variety of new payment models designed to enhance care coordination, quality, appropriateness and costs would be tested. This period would also provide time to carry out demonstration and pilot projects that would form the basis for a new Medicare physician payment system. Because fiscal stability is imperative, the AMA recommends positive payment updates that keep pace with growth in medical practice costs over this period.

“A replacement for the SGR should not be another one-size-fits-all formula,” said Dr. Wilson. “A new system should allow physicians to choose from a menu of new payment models that rewards physicians and hospitals for keeping patients healthy and managing chronic conditions.”

To assist with the process of testing and evaluating payment models, the AMA is working with specialty and state medical societies to form a new Physician Payment Reform and Delivery Leadership Group. This group will include physicians who are currently participating in payment and delivery innovations and other experts. By sharing expertise and resources, physicians can assess the models that will improve patient care, learn how to get programs off the ground, address challenges and determine the impact of these reforms on patient care and practice economics.

——

LAGNIAPPE: Still on the road.  At an airport hotel tonight in Sacramento.  Fly to Columbus, Ohio at 7 a.m. and then get a ride to Cincinnati.  Will speak to the Ohio Chapter of the American College of Surgeons Saturday re leadership and health system reform.

Stay well!

Donald

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