The Senate Finance Committee on April 28 released the first in a series of policy options for health care reform. The document "Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs," addresses short and long-term payment reform options and infrastructure investments to support delivery system reform. The committee is expected to release similar proposals addressing coverage and financing in the coming month, with the goal of receiving input from the Senators and the public, including the physician community, before crafting a bipartisan health reform plan for the committee to act on in June. 

The Finance Committee is accepting public comments on the document through May 15. The ACC will provide members with more detail on the Finance Committee policy options in the coming days and will submit comments. The ACC continues to work with members of Congress and their staff to ensure that any draft legislation will strengthen, not hinder, the ability of practices to provide quality care to their patients.

Document Highlights

Sustainable Growth Rate (SGR) Options
The paper outlines options for a multi-year Medicare physician payment patch but no long-term reform. It states that the committee is continuing to explore physician payment options. The ACC will continue to advocate for a long term solution to the flawed payment formula; we are concerned that after two years of positive updates, physicians would face significant payment cuts under the options proposed.

Physician Quality Reporting Initiative (PQRI)
The paper proposes improvements to the PQRI including an appeals process and more timely feedback, proposes a new maintenance of certification participation option, includes options for continuing incentive payments for the next few years, but then proposes penalties for failure to successfully participate. The ACC supports improvements to the PQRI program and continued incentive payments, however we have serious concerns with moving forward with penalties under the current program. 

Imaging
The paper proposes several new options the committee is exploring to reform how imaging is delivered and paid, including requiring disclosure to patients at the time of a referral about any financial interest in certain advanced imaging services; establishing a diagnostic imaging exchange; creating a confidential education and feedback program; providing incentive payments based on adherence to appropriateness criteria; or using radiology benefit managers for certain imaging services. The ACC supports efforts to help physicians order imaging appropriately, but has significant concerns with the use of radiology benefit managers in the Medicare program.

Primary Care and General Surgery Bonus
The paper proposes bonuses of at least 5 percent for five years for primary care physicians, as well as for general surgeons serving in newly defined rural general surgery scarcity areas. This would be paid for by across the board cuts for all other codes or from other funding sources. The ACC supports efforts to bolster primary care, but does not support doing so by cutting payment for other critical Medicare services.   

Quality Measurement
The paper proposes providing increased resources for strengthening and improving the quality measurement and development processes and requiring the Secretary to develop a strategy for improving the public reporting of quality and performance information.

Specialty Hospitals
The paper proposes elimination of the whole hospital and rural exceptions with grandfathering of hospitals in effect by July 1, 2009 who meet certain requirements. The ACC opposes efforts to limit specialty hospitals.

Physician-Industry Sunshine
The paper proposes setting a plan for transparency in the relationship between physicians and manufacturers.

Other Issues

• Timeline for rolling out new policies related to bundling and readmissions 
• Options for addressing the workforce crisis
• Timeline and policy options for allowing groups of providers to share in Medicare cost-savings
• Long-term framework outlining national priorities for comparative clinical effectiveness research