Health Care Reform: Comparing Both Proposals

October 1, 2009

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The US Senate Finance Committee has begun considering a health care reform proposal, while the US House has passed legislation through three different committees and is moving closer towards a floor debate. The Academy has been tracking these issues closely. Below is the current status (as of September 25, 2009) of health care proposals in the House and Senate:

Sustainable Growth Rate

The Academy has worked with other physician groups to push for the replacement of the flawed Sustainable Growth Rate formula (SGR). Specifically, the Academy supports the establishment of a separate service category and conversion factor for evaluation and management (E/M) services, which recognizes the importance of patient centered care.

House: Eliminates the current deficit created by the SGR and eliminates a 21 percent cut in physician reimbursement scheduled for January 1, 2010; the Academy strongly supports this provision; the House replaces the SGR with new spending targets that should equal increases for neurology

Senate: Provides an increase of 0.5 percent for 2010; the Senate proposal does not currently address replacing SGR

Primary Care Bonus

Both House and Senate proposals contain a bonus for primary care providers. Unfortunately, the proposals do not currently include neurology within the same category as primary care. The Academy is working with members of Congress on both sides of the Capitol to include neurology in these bonuses, which are designed to provide incentives to physicians providing high percentage of E/M services. The Academy supports a 5-to-10 percent bonus payment that is applied to principal care physicians in addition to primary care physicians. Any physician groups who receive more than 50 percent of their total allowed charges from E/M services should also be eligible for the 5-to-10 percent bonus payment.

House: 5 percent bonuses to physicians who specialize in family medicine, general internal medicine, general pediatrics, geriatrics, or obstetrics and gynecology (10 percent to those who practice in a designated primary care health professional shortage area)

Senate: 10 percent Medicare bonus to family medicine, internal medicine, geriatric medicine, or pediatric medicine

Comparative Effectiveness

The Academy is supportive of comparative effectiveness initiatives, but has concerns about the current House language, as it fails to address how any comparative effectiveness determinations will be made.

House: Supports comparative effectiveness research by establishing a Center for Comparative Effectiveness Research; an independent Comparative Effectiveness Commission will oversee the activities of the Center

Senate: Does not currently address comparative effective, though amendments are expected to be offered during the Senate Finance Committee's mark up

Physician Quality Reporting Initiative (PQRI)

The Academy supports provisions that would provide timely feedback to participating professionals, offer an appeals process to correct errors, and extend incentive payments through 2012. The Academy supports integration of quality reporting with the meaningful use of electronic health records (EHR).

House: Continues to extend the PQRI though 2012

Senate: Physicians would be required to participate in PQRI by 2011 or face a payment penalty

For questions or comments, contact Mike Amery, AAN Legislative Analyst, at mamery@aan.com.