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Podcasting Archives

NARR: Is the debt deal a raw deal for doctors? Welcome to Policy and Practice, the weekly podcast from Global Medical News. I'm Frances Correa.

NARR: President Obama signed the debt ceiling agreement into law last week, setting in motion a process that will cut Trillions in federal spending. But physicians' biggest complaint isn't what's in the debt deal - it's what's not. The agreement didn't fix the formula responsible for the looming 30 percent cut in Medicare fees - the Sustainable Growth Rate formula. And unless Congress acts to avert the cuts, patients are likely to feel the pinch. That's according to Dr. Roland Goertz (Gerr-itz) of the American Academy of Family Physicians:

GOERTZ: "There's little doubt that there'll be access issues that will be created. I think that physicians will have to make a decision about their practices as to whether or not to take new Medicare patients and in some cases they'll decide not to participate at all. That would create a problem for access for Medicare patients."

NARR: What the debt agreement does do, is set up a bipartisan committee on deficit reduction. This so-called super committee of twelve lawmakers will meet this fall to cut between 1.2 and 1.5 Trillion dollars from the federal budget. There are NO restrictions on what can be cut -- leaving Medicare, Medicaid, and the Affordable Care Act vulnerable. And if the committee deadlocks, or if Congress can't pass their proposal, the Budget Control Act automatically triggers cuts. Those include reductions in Medicare payments to physicians, capped at 2 percent per year starting in 2013.

NARR: In the meantime, health reform rolls on. The Health and Human Services department issued a list of preventives services insurers must cover for women at no cost. The agency accepted whole cloth the list of services recommended last month by the Institute of Medicine. Among other things ... health plans must cover contraception methods approved by the Food and Drug Administration. HHS Secretary Kathleen Sebelius said it's just common sense.

SEBELIUS: "Since birth control is the most common drug prescribed to women ages 18 to 44, insurance plans should cover it. Not doing it would be like not covering flu shots or any of the other basic preventive services that millions of Americans count on every day."

NARR: New health plans must begin covering these services without copays, coinsurance, or deductibles starting next August. But certain religious employers will be exempt from offering contraception coverage, if it conflicts with their beliefs.

NARR: Switching gears ... new research shows that insurance paperwork costs U.S. physicians a pretty penny. A study published in the journal Health Affairs found that American doctors are paying nearly 83,000 dollars a year just to deal with health plans. That's four times as much as their counterparts practicing in Ontario, where doctors work in the Canadian single payer system. Researchers said the biggest issue is that American physicians have to deal with so many different payers. But standardizing transactions and relying more on electronic systems could help reduce the burden, they wrote.

NARR: We'll be taking a break next week. But join us again August 22nd to hear more about the new deficit reduction super committee and what it means for health reform. And that's the Policy and Practice podcast. I'm Frances Correa.

NARR: Health reform...a big bang for the buck? Welcome to the August first edition of Policy and Practice, the weekly podcast from Global Medical News. I'm Frances Correa.

NARR: Federal economists released their annual accounting of the nation's health spending. In it: the not-surprising revelation that health costs grew just under three percent in 2010, due to the recession. But the economists offered a prediction too: In 2014, when the Affordable Care Act kicks into high gear, spending will only jump by 2 percent over the yearly average for the next decade. But there are plenty of uncertainties affecting this estimate. Will a federal debt deal create more Medicare cuts? What will Congress do about the massive looming physician pay cut under the Sustainable Growth Rate formula? Medicare's chief actuary, Rick Foster, said his team stands by their numbers, but they can't predict what will happen with policy.

FOSTER: "It's always a dangerous business to try and anticipate what Congress may or may not do. So we can safely conclude they're going to address the SGR for 2012. Exactly how they do it, whether they do it for a longer period, whether they consider other means of offsetting the costs, that's where it gets pretty speculative."

NARR: While physicians wait and see on the fate of the SGR, they may be wondering what will happen with the Independent Payment Advisory Board. Here's Mary Ellen Schneider with more:

SCHNEIDER: The I-PAB was created under the Affordable Care Act with broad authority to recommend Medicare cuts starting in 2015. Republicans have come out hard against the panel, but now an effort to repeal the I-PAB is gaining a bit of bipartisan momentum. Since the bill's introduction in January, ten House Democrats have signed on to support a bill repealing the I-PAB. The list includes Congresswoman Donna Christensen of the Virgin Islands, who chairs the health care task force for the Congressional Black Caucus. The repeal effort also has the support of Democratic Congresswoman Allyson Schwartz of Pennsylvania. She recently testified before the House Energy and Commerce Committee that one reason she wants to repeal the I-PAB is because it would potentially stifle innovative cost-containment ideas in the Affordable Care Act.

NARR: And weeks of contentious debate have finally led to a deal to raise the nation's debt limit. The deal calls for spending cuts to reduce the deficit by a trillion dollars over 10 years. It would also create a bipartisan committee tasked with finding another 1.5 trillion in cuts. That committee has free reign to look at entitlement programs like Medicare, putting cuts to physician pay on the table. The committee must send its proposal to lawmakers by Thanksgiving and Congress must give it an up or down vote by the end of this year. One thing missing from the current deal is a fix to the SGR. The House and Senate are expected to vote on the debt ceiling legislation today or tomorrow.

NARR: Join us next week for more fallout from the debt ceiling agreement and how states are preparing for health reform implementation. And that's the Policy and Practice podcast. I'm Frances Correa.

NARR: More pieces of the reform picture fall into place. Welcome to the July 25th edition of Policy and Practice, the weekly podcast from Global Medical News. I'm Frances Correa.

NARR: The White House and Congress are busy on negotiating the debt ceiling and the federal deficit.... but that's not slowed the pace of health reform. Government officials pulled back the curtain on several more initiatives that are part of the Affordable Care Act.

NARR: First, the Centers for Medicare and Medicaid Services announced 3.8 billion dollars in loans to create consumer-operated health plans, or co-ops. The co-op program will function like the planned state-based health insurance exchanges. But co-ops will also be required to use profits to lower premiums, improve quality, or upgrade benefits.

NARR: Officials also previewed upcoming rules on bundling pay in Medicare-- seen by proponents as a key way to curb costs and to encourage efficient care. Here's White House Deputy Chief of Staff Nancy-Ann DeParle:

DePARLE AX: "In the weeks ahead, we'll be launching a series of different models that give providers the opportunity to receive bundled payment and keep the savings they generate. These models will cover care in hospitals and post-acute facilities."

NARR: Ms. DeParle said that providers could start participating as soon as this year.

NARR: And the Institute of Medicine came out with recommendations on what preventive services health plans should cover for women. The IOM recommended that eight preventive services be offered to women for free. On the list.... birth control and emergency contraception. Other recommendations were less controversial. They included gestational diabetes screening, HPV testing for women over 30, STD counseling, breastfeeding support, domestic violence screening, and annual well-woman checkups. HHS officials will decide... perhaps by August 1st... whether to include these items on its list of recommended preventive care services. Under the Affordable Care Act, health plans must cover services on the HHS list without cost sharing starting in 2014.

NARR: And as the debt ceiling debate continues to consume elected Washington, physicians continue to push for the bill to include a fix to the Sustainable Growth Rate formula. The SGR helps set Medicare payments and doctors universally agree it's got to go. Now with an environment of tight budgeting and the 2012 election on the horizon... the debt limit debate could be the last, best chance physicians have for a permanent SGR fix this year. That's according to Bob Doherty, senior vice president for government affairs and public policy at the American College of Physicians.

DOHERTY AX: "It's very hard to see a scenario outside of an agreement on the debt ceiling, where we could get anything close to permanent SGR solution. A couple of reasons for that: One is, it's easier to deal with the SGR and the at least 300 billion dollar cost over 10 years in a 4 trillion dollar package, than if you try to get conservative members of Congress to vote for spending on paper of 300 billion dollars outside of a broader deficit reduction package. The other thing is you're likely to use up all your offsets."

NARR: Join us next week for an update on the debt ceiling and more on health reform implementation at the federal and state level. And that's the Policy and Practice podcast. I'm Frances Correa.

NARR: Medicaid and doctors' payments on the block. Welcome to Policy and Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: States only have a few years left to figure out how they'll manage the massive Medicaid expansion included in the Affordable Care Act. Now a study in the journal Health Affairs gives states some clues as to how they can reduce high priced hospital stays by Medicaid beneficiaries. Researchers looked at hospital and outpatient costs for disabled Medicaid beneficiaries around the country. They found that states that had more primary care physicians and paid more for outpatient visits tended to have fewer hospital admissions. Todd Gilmer, a health economist at the University of California in San Diego, explained how states can use the results to improve their programs.

GILMER: "Overall, they could use the evidence we've found of more robust primary care systems leading to fewer admissions to provide a hopeful note that if they kind of make these investments in primary care that they will see improved quality of care and lower admission rates in their state."

NARR: In other action, Medicare made it official: unless Congress steps in to make a change, physicians are looking at a 30 percent pay cut next year. Here's Alicia Ault with more:

AULT: The proposed pay cut was expected because it's in line with what's called for by Medicare's Sustainable Growth Rate formula. Even so, the looming reduction is likely to kickstart efforts to eliminate the cut and to find a better payment method. As has happened so many times over the past decade, Congress could step in and offer a short term pay fix. The Obama Administration wants a permanent SGR replacement, as do most physician groups. And there's an increasing sense of urgency. The American Medical Association estimates that it would cost $300 billion to replace the SGR over the next ten years. But without any action, that cost will quickly balloon to a few trillion dollars.

NARR: Medicare is accepting comments on its fee proposal through August. A final rule is expected in November.

NARR: Meanwhile, the SGR is also figuring in to talks to raise the debt ceiling. A group of more than a hundred state and medical specialty societies is pushing negotiators to eliminate the SGR as part of any debt ceiling agreement. And while it's costly to replace the formula, the doctors say it would be bad budgeting to count the expected savings from SGR-related cuts to doctors when Congress has no intention of letting those cuts go into effect.

NARR: Well, stay tuned for more on the debt ceiling negotiations and new rules for state-based health exchanges. And that's the Policy and Practice podcast. I'm Todd Zwillich.