Specialty groups make health reform pitch

Jul 01, 2017

As the Republican-led Congress wrestles with the daunting challenge of developing comprehensive health care legislation to replace the Affordable Care Act, specialty organizations-including those representing urology-are working to influence the ultimate outcome.

Bob GattyAs the Republican-led Congress wrestles with the daunting challenge of developing comprehensive health care legislation to replace the Affordable Care Act (ACA), specialty organizations-including those representing urology-are working to influence the ultimate outcome.

In a letter to Senate Finance Committee Chairman Orrin Hatch (R-UT) in late May, members of the Alliance of Specialty Medicine, including the AUA, provided a list of recommendations for inclusion in the Senate’s version of the legislation, on which Senate leaders have been hoping to take to a vote before the August recess.

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The House of Representatives narrowly passed a reform bill, HR 1628, in May, which has raised alarms about potential loss of coverage under Medicaid and for preexisting conditions, among other issues. Differences between the two versions of the legislation would then be negotiated in a House-Senate conference to devise a final bill to be considered in each chamber.

The Alliance’s letter summarized what many specialty groups, including the AUA, have been urging senators individually to consider during meetings on Capitol Hill and elsewhere.

Some provisions of the reform effort are being handled through the budget reconciliation process in Congress, while others that do not have a direct impact on the federal deficit will be included in separate legislation.

Next: Networks must include sufficient specialists

 

Networks must include sufficient specialists

Under budget reconciliation, the Alliance stressed the importance of making certain that provider networks include sufficient numbers of specialists and subspecialists per enrollee. In addition, network directors should be updated in real time and patients provided with clear, concise, and accurate information. Finally, the Alliance said, decisions to remove a physician from the network without cause should not be made in the middle of a contract year.

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“We urge the committee to ensure appropriate oversight to hold insurers accountable to ensure patients have timely access to the right care, in the right setting, by the most appropriate health care provider,” the Alliance’s letter said.

In addition, the Alliance said these provisions should be maintained to ensure access to affordable health insurance and access to specialty medicine:

  • Eliminate exclusions in coverage for pre-existing conditions, as is now provided by the ACA.

  • Provide adequate access to specialty care through any benefit package.

  • Protect against the rescission of health coverage.

  • Ensure continuity in Medicaid coverage for children who go in and out of the system.

  • Ensure coverage for routine services provided in conjunction with clinical trials.

  • Ensure access and coverage of preventive screening services.

  • Prohibit annual and lifetime coverage limits.

The Alliance said its recommendations stemmed from the results of a survey of 1,000 provider members to determine the extent to which those issues placed a burden on timely access to specialty care.

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“The results indicate that these barriers to care have gotten far greater and more difficult to navigate in recent years,” the Alliance explained.

Next: IPAB repeal, liability reform urged

 

IPAB repeal, liability reform urged

As the legislation to be considered through the “regular order” process is developed, the Alliance urged:

  • repeal of the Independent Payment Advisory Board, which has been opposed by organizations representing urology as well as many other physician groups since it was established by the ACA “The Alliance strongly supports repealing the IPAB, which inappropriately delegates Congress’ oversight responsibilities to an unaccountable board of government bureaucrats,” the Alliance declared. The IPAB was created to impose spending cuts on Medicare in the event certain targets are reached.

  • medical liability reform, including limits on non-economic damages

  • addressing work force shortages, a particular concern in urology given the increasing numbers of retirements compared to the influx of new physicians “While medical schools in the U.S. have increased their enrollments, and additional medical and osteopathic schools have been established, the number of Medicare-funded resident positions has been capped by law at 1996 levels,” wrote the Alliance.

  • medical specialty representation on the U.S. Preventive Services Task Force “We urge the committee to consider the bipartisan “USPSTF Transparency and Accountability Act,” the Alliance said. The legislation would ensure input from medical specialists, and regularly engage interested stakeholders and scientific and medical experts in the subject matters under review. AUA reports having met with numerous congressional offices in support of that legislation, noting that many were unaware that it had been introduced.

  • maintaining a viable fee-for-service option, particularly since many communities do not have many health plans from which to choose and may not have an adequate number of specialists in those plans

  • implementing an option under Medicare that would allow patients to privately contract for services directly with their physician and get reimbursed by Medicare. Currently, beneficiaries who wish to do so must pay for those services out of their own pocket – and, if a physician opted out of Medicare to contract privately, even with one patient, he or she is ineligible for Medicare reimbursement for 2 years. “Congress should eliminate the 2-year Medicare exclusion for physicians who privately contract, and allow patients who privately contract to recoup the amount Medicare would otherwise pay for the service,” the Alliance said.

  • refining the authority of the Center for Medicare and Medicaid Innovation (CMMI), which was established to provide a research and development platform to experiment and evaluate new payment and delivery approaches. The Alliance said the CMMI’s authority should be refined to ensure that demonstration authority is not “overly broad” and that participation in CMMI-approved payment models is voluntary.

  • exempting continuing medical education from physician Sunshine Act reporting requirements established by the ACA. The Alliance opposes a decision by the Centers for Medicare and Medicaid Services that accredited CME and reprints of peer-reviewed journal articles and medical textbooks do not directly benefit patients and are not intended for patient use, and thus must be reported in the same manner as cash payments.

Whether the Senate will be able to finalize comprehensive health reform legislation and achieve a vote prior to the August recess was in question at press time. Meeting that time frame would allow lawmakers to return in September and tackle an ambitious legislative agenda, including tax overhaul, funding the government through fiscal year 2018, increasing the debt ceiling to prevent default, and more.

Regardless, however, whatever legislation is finally approved by the Senate is just one additional step toward final enactment, as a compromise bill must be negotiated with the House of Representatives and then both chambers must act before sending a final bill to President Trump.

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