Article 4
How Health Care Bill HR 3200 May Affect Physicians
To: Physicians and Interested Parties
From: John J. Rivas, Esq.
Date: August 7, 2009
The proposed Health Care Bill HR 3200, which was just passed by the United States House and will be considered by the Senate in September, contains many provisions that may affect physicians and their practices. The following are the most relevant provisions for physicians and their practices.
PROMOTING ACCOUNTABLE CARE ORGANIZATIONS
An "Accountable Care Organization" is an organized group of physicians who are rewarded for providing high quality care at low cost over a sustained period of time. Section 1301 directs the Secretary of Health and Human Services to create an alternative payment model by establishing a comprehensive ACO pilot program and authorizes the continued expansion of the program where it proves successful in improving quality and keeping costs under control.
PROMOTING PAYMENT BUNDLING
Hospital and physician incentives can be restructured by paying a lump sum for an episode of care ("bundling" payments), rather than paying separately for each service provided. Section 1152 directs the Secretary to establish pilot programs to test the effectiveness of payment bundling across the nation in a wide array of formats in order to learn the best way to bundle payments to encourage efficiency and ensure quality. Section 1152 converts the existing Acute Care Episode demonstration to a pilot program that expands the program to include bundling of payments to hospitals and post acute providers.
REDUCING HOSPITAL READMISSIONS
Section 1151 uses new financial incentives to encourage hospitals and post-acute providers to undertake reforms needed to reduce preventable readmissions, which will improve care for beneficiaries and rein in unnecessary health care spending.
REWARDING HIGH-QUALITY AND EFFICIENT CARE
Section 1162 provides for increased payments to Medicare Advantage plans that demonstrate high quality of care and outcomes and plans that significantly improve quality.
PROMOTING THE "MEDICAL HOME" MODEL
Section 1302 directs the Secretary to establish a pilot program to reward physicians and nurse practitioners who make their offices a "medical home" for patients by being fully available to patients and by ensuring that patient care is coordinated and comprehensive. The Secretary is authorized to expand the medical home concept if it proves effective in improving quality of care and holding down costs.
PROMOTING "SHARED DECISIONMAKING"
Section 1235 directs the Secretary to establish a demonstration program to evaluate the benefits of having doctors spend more time consulting with their patients about various treatment options.
PROMOTING PRIMARY CARE
Since primary care providers can provide lower cost and higher quality care for many ailments, Section 1303 increases payment rates for primary care physicians by 5% and provides an additional 5% payment increase for primary care physicians in health shortage areas. Section 1121 provides for preferential updates for payment rates for primary care services in Medicare. Section 2212 expands scholarships and Section 2211 creates a new loan repayment program to train more primary care physicians. Section 2201 builds on current expansions to the National Health Service Corps to get more physicians to health shortage areas, and this expansion in the Corps could eliminate 40% of the current estimated deficit in primary care providers. Sections 1501 and 1502 encourage more training of primary care medical residents and advance training in the outpatient setting, where most primary care is delivered.
DISCLOSING FINANCIAL RELATIONSHIPS
Section 1451 requires manufacturers of drugs and devices to report their financial relationships with health entities, including physicians, pharmacies, hospitals and other organizations. Physicians are also required to disclose ownership in hospitals or any agency that bills Medicare.
UPDATED PAYMENT RATES
Sections 1101 and 1102 freeze payment rates to skilled nursing facilities and inpatient rehabilitation facilities for 2010. Section 1154 adopts payment changes to Home Health Prospective Payment System. Sections 1103, 1131 and 1155 adjust payments so that providers, such as skilled nursing facilities, are encouraged to increase productivity.
MORE AND BETTER HEALTH CARE DATA
The transition to a more efficient, higher-quality health care system depends on obtaining more data about the clinical effectiveness of medical procedures. Section 1401 invests $2.9 billion in comparative effectiveness research. Sections 1124, 1441 and 1443-1145 expand physician and hospital reporting of quality measures. Section 2531 creates a registry to track the use of medical devices. Section 1442 directs the Secretary to develop improved measures of health care quality. Section 2402 creates the Assistant Secretary for Health Information to provide ongoing monitoring and reporting on critical population health data.
DEVELOPING NEW INNOVATIVE PRACTICES TO IMPROVE QUALITY
Section 2401 creates the Center for Quality Improvement at the Agency for Healthcare Quality and Research in order to identify existing best practices, develop new best practices and disseminate successful models around the country.
LIMITATION ON PHYSICIAN OWNED HOSPITALS
Section 1156 prohibits physician ownership in new hospitals as of January 1, 2009, grandfathers physician owned hospitals existing prior to January 1, 2009 and places limits on growth of existing physician owned hospitals.
PAYMENTS FOR COST EFFICIENT AREAS
Section 1123 provides incentive payments in the Medicare Program to physicians practicing in areas that are identified as being the most cost-efficient areas of the country.
Rivas Goldstein, LLP is a Health Care law firm located in Austin , Texas that focuses on legal and compliance issues affecting health care providers and entities.
P. (512) 481-8000
www.RivasGoldstein.com
References:
http://www.slate.com
http://thomas.loc.gov
http://www.physiciansnews.com
http://www.stark.house.gov |