Health Care Reform Information

 

Independent Payment Advisory Board: The American Medical Association in a letter to members of the U.S. House Energy and Commerce Committee,A supported a bill that would eliminate the Independent Payment Advisory Board (IPAB).

Patients would have direct access to their laboratory test results under a proposed rule issued by HHS (HHS release, 9/12). The proposed rule in the Sept. 14 Federal Register would modify the Clinical Laboratory Improvement Amendments of 1988 and the Health Insurance Portability and Accountability Act of 1996. These two statutes limit the release of test results directly from laboratories to patients in states that do not have laws allowing test results to be given to patients directly.

Health Insurance Exchange

NYS health exchange bill: The New York Health Benefit Exchange Act (S. 5849) passed the Assembly last month. The Senate has not yet passed the legislation, but is expected to come back to Albany later in the year to pass the bill or a variation of it. Read MSSNY's summary of the bill.

Health Insurance Exchange: Last spring, the NYS Insurance Department held public forums to present their ideas on the design of the state's health insurance exchange. Robert J. Hughes, MD, FACS, president-elect of the Medical Society of the State of New York, presented testimony at a public forum held on May 16, 2011 in Albany. Click here to read his statement.

Resources from the AMA for dealing with NYS of Health Exchange patients who are in their “grace period” with regard to their failure to pay their full premium payments:

Step-by-step guide to the ACA grace period
Sample letter: Grace period notice to patients
Model collection policies for grace period patients
Model financial agreement language for patients receiving Advance Premium Tax Credits

Accountable Care Organizations

Accountable Care Organizations: The Department of Health and Human Services has released for public comment the long-awaited proposed rules governing accountable care organizations. Here are some other resources from the Department of Health and Human Services on the proposed ACO regulation:

ACO Overview Fact Sheet
ACO Fact Sheet Summary of Proposed Regulations
ACO Fact Sheet for Providers
ACO Fact Sheet for Consumers
ACO Fact Sheet on Legal Issues Around ACOs
ACO Fact Sheet On Quality Scoring

Accountable Care Organizations – Panacea or Placebo?

By: Mathew J. Levy, Michael J. Schoppmann & Stacey Lipitz Marder 
Since the passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) brought about the introduction of a previously heretofore unheard of concept known as a “accountable care organizations” (ACOs), there has been a growing conversation in the medical community centered around two primary questions ‐ what are ACO’s and what do the foretell as to the future of medicine? ACOs were introduced as a Medicare savings program, intended to enhance quality, improve beneficiary outcomes and increase the value of care through incentives to healthcare providers. Although PPACA mandates that the federal government establish an ACO‐based Medicare shared savings program by January 1, 2012, at this juncture there has been little guidance issued by the federal government with respect to these ACOs and how they will be structured. more

Medical Home

Patient centered medical home: John M Ventura, DC, a charter member of the MCMS Integrated Health Committee, has written an article about the application of patient centered medical home characteristics to spine care that was published in Becker’s Orthopedic, Spine and Pain Management magazine, published April 12, 2011.

National Committee for Quality Assurance (NCQA): A private, 501(c)(3) not-for-profit organization dedicated to improving health care quality.

Red Flags Rule

Red Flag Appeals Court Ruling Victory for Physicians: A federal appeals court issued a decision that further validates the American Medical Association's long-standing argument to the Federal Trade Commission (FTC) that physicians who bill after rendering services are not subject to the red flags rule as creditors.

Clarification Act of 2010: President Obama has signed into law the Red Flag Program Clarification Act of 2010.This legislation narrows the scope of the Red Flags Rules definition of "creditor" and relieves some physicians of having to comply with the FTC’s identity theft prevention law.


SUMMARY from MSSNY: WHAT HCR PASSAGE MEANS FOR NYS PHYSICIANS 

The House of Representatives on Sunday night in separate votes approved the Senate health reform bill (HR 3590) which now proceeds to President Obama to be signed into law, and the so-called "corrections" bill (HR 4872) which contains a series of changes favored by the House.  Many provisions in the bill will positively benefit physicians as well as their patients.  However, there are other issues which MSSNY has serious concerns and will continue to work aggressively with the AMA and the New York Congressional delegation to address.   The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology, the American Osteopathic Association, the National Medical Association and the National Hispanic Medical Association each announced support for the bill.  The American Medical Association, while noting that the bills are imperfect, announced its qualified support for the measure.  Analysis of these enormous bills is underway. Click here for an interim summary of some of the positive and negative aspects of these bills.

Healthcare Reform Resources

Patient Protection and Affordable Care Act and the subsequent reconciliation bill.  (more)

Medicare Payment Cuts Postponed for 31 days
Congress fails to address 21% Medicare SGR Cut but action promised next week. Read the statement issued by MSSNY President David Hannan, MD (more)

America’s Affordable Health Care Choices Act-Section Analysis, July 14, 2009
http://waysandmeans.house.gov/
media/pdf/111/sbys3200.pdf

Statement and Commentary

Physician Views on the Public Health Insurance Option and Medicare Expansions
Majority of Physicians Support Health Reform that Includes both Public & Private Insurance Options
Focus on Healthcare Reform-Side by Side Comparison of Major Healthcare Reform Proposals

Update from the AMA

(01/26/2010) Implementation Timeline

View the H.R. 3962 and H.R. 3590 Legislative Summary Chart of Major Provisions

Links for More Information

American Medical Association http://www.ama-assn.org
American College of Physicians http://www.acponline.org/pressroom/affordablecare.htm?hp
Kaiser Foundation  http://kff.org/health-reform 
Medical Society of the State of New York http://www.mssny.org/
US House of Representatives http://www.house.gov
US Senate http://www.senate.gov