GOP targets Medicare payment advisory board


With Republicans in control of the House of Representatives, there is some potential good news and bad news for physicians, including urologists, as the drive to slash the federal deficit moves into high gear.

First, the good news... on two fronts.

The long-fought effort to achieve at least some degree of medical malpractice reform finally may have a chance of succeeding as two important bills have been introduced with strong support among House Republicans who dominate that chamber, offering supporters hope of at least partial success over the next 2 years.

The AUA strongly opposes the IPAB on grounds that it would give nearly unfettered power over Medicare physician fees to an unelected group of bureaucrats. Whether that effort is eventually sustained is in question, but even if it dies as part of a funding deal with the Democrat-controlled Senate, there is clearly strong opposition to the IPAB in the House, and additional efforts can be expected.

EHR funding in danger?

The bad news is that those same House Republicans are working to repeal several provisions of last year's stimulus law in an effort to recoup unexpended funding intended to help physicians and hospitals acquire equipment and software to establish a new electronic health record (EHR) network. Thus, doctors who have made plans to purchase that technology could find themselves without the financial support they had expected.

The effort is part of the ongoing budget debate, and while it has the support of most Republicans, chances for enactment appear to be slim since Democrats control the Senate and President Obama can exercise his veto pen-and he has repeatedly emphasized the importance of the EHR program to his overall goal of improving health care.

"This would really hurt small practices who have been counting on this money," said Karen Lencoski, JD, MBA, government relations and advocacy manager for the AUA.

While the GOP initiative in the House was specifically focused on pulling back unexpended stimulus funds, it did not appear to affect the overall HITECH (Health Information Technology for Economic and Clinical Health) Act, which authorized the EHR program.

As of Feb. 23, more than 21,000 providers had signed up for the EHR program and more than 45,000 providers requested information or registration assistance from the agency's 62 Regional Extension Centers. The Centers for Medicare & Medicaid Services said that four-fifths of the nation's hospitals and 41% of office-based physicians intend to sign up for the payments.

Those payments could reach $44,000 over 5 years for eligible professionals under the Medicare EHR incentive program, with even more money possible for providers located in health professional shortage areas. To get the maximum amount possible, providers must start participating by 2012. The Medicaid EHR program provides up to $63,750 over 6 years for eligible professionals.

On the medical malpractice front, Rep. Phil Gingrey, MD (R-GA), has reintroduced the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, which includes a number of long-sought provisions designed to reduce malpractice insurance costs.

AUA President Datta Wagle, MD, wrote to Dr. Gingrey in January expressing support for the bill, which previously has been introduced but has not been successful. However, with the strong GOP majority in the House, it is possible that it can be approved there this year. The measure's fate in the Senate, however, is more uncertain.

'Shield Act' endorsed by the AUA

A second initiative by Rep. Henry Cuellar (D-TX) and Dr. Gingrey also has drawn the support of the AUA. That bill, the "Provider Shield Act of 2011," would protect physicians from a possible cause of action inadvertently resulting from provisions of the Affordable Care Act.

"Unfortunately, a lack of clarification in the Affordable Care Act (ACA) leaves providers potentially open to new causes of action in areas of the law that deal with compliance with quality reporting provisions, hospital readmissions, hospital-acquired conditions, and other related provisions," Dr. Wagle said in a Feb. 23 letter to Rep. Cuellar. The ACA requires the Government Accountability Office to determine whether any ACA provisions would result in a new cause of action or claim and report to Congress within 2 years.

Regarding the IPAB, Dr. Hayworth pointed out that the only option the Board will have to control Medicare spending would be to reduce payments to physicians and hospitals.

"If members [of Congress] believe that the cuts proposed by IPAB won't work or are too draconian, it will take an affirmative act by future Congresses to overturn its recommendations," she said. "This represents an abdication of responsibility by Congress, whose members are expected to make these decisions, not unelected, unaccountable federal bureaucrats."

Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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