Medicare Physician Payment Reform

We must seize the opportunity to replace, once and for all, the flawed SGR payment formula. New Medicare patients in Arkansas increasingly have difficulty finding physicians who are willing to take new Medicare patients. The lack of a funding formula that recognizes increases in practice costs, plus the geographic adjustments that make Arkansas the "lowest" reimbursed state in the country are having a significant impact on access and our ability to recruit physicians. We ask that you actively pursue a permanent SGR fix as an integral part of health system reform. Also, we simply cannot support the most recent proposal to provide a Medicare buy-in for the 55-64 age group, given the current state of Medicare and the proposed new requirements already contained in the bill.

Insurance Reform

We generally support the insurance reforms in the bill. However, Title I, on pages 200 and 219, contains troubling language that could allow insurance plans to escape state insurance laws. Many state consumer protection laws, patient access laws, and provider protection laws could be gutted as a result of these provisions. Arkansas' Patient Protection Act, which ensures that patients choose their physician, not insurance companies, is one such state law that could be in jeopardy. We ask that you support or offer an amendment to ensure that state consumer protection laws are not pre-empted by this legislation, or conversely, oppose any provision or amendment that would have the effect of pre-emption.

Private Contracting

The bill fails to provide patients a true choice of physician by not including a private contracting provision. At a minimum, provisions should be added to require adequate "out-of-network" benefits in all plans created by the bill or participating in programs created by the bill. This provision is particularly important for the Community Health Insurance Option.

Medical Liability Reform

We are well aware of the political realities of non-economic damage caps and limits on attorneys' fees. However, other meaningful reforms could be included in the bill that would be strongly supported by Arkansas physicians. One example would be a requirement that plaintiff attorneys file an affidavit of merit within 30 days of filing a claim. This provision helps reduce the large number of non-meritorious claims, which some studies indicate represent up to 70% of filings. These claims burden the Court system, add unnecessary costs, and are usually dropped or dismissed.

Independent Medicare Advisory Board

We cannot support an independent commission with unprecedented authority to make physician payment cuts. This provision could be corrected with an amendment to remove the "independent" provisions and thus Congress would retain its ability to make these decisions based upon recommendations that have been subjected to public input. Additionally, as presented, this provision would insulate some providers from possible cuts (during the first few years) thereby placing an even larger burden on those that remain.

Value Based Payment Modifier

We oppose budget-neutral provisions to redistribute Medicare payments based on measures that CMS currently does not have the capability to implement. If Congress wishes to go down this road, this provision should be amended to authorize a study of potential mechanisms and their impact on access and quality before diving headfirst into risky new territory.

Physician Quality Reporting Initiative (PQRI)

Considering the large volume of new mandates being placed on physicians, we do not support mandatory reporting of quality measures with penalties for non-reporting. Voluntary reporting should continue to be encouraged with appropriate incentives, at least until such time as CMS resolves problems with the existing PQRI program.

Funding Provisions

We oppose the following funding provisions and urge you to offer or support amendments to remove them from the bill:

The imaging cuts contained in the bill and the 2010 Final Rule on Physician Medicare Payments will have a devastating effect on access to these services in Arkansas. The existing utilization assumptions should be retained until providers of these services and CMS work to develop a more accurate utilization rate.

The physician enrollment fee for Medicare/Medicaid will be viewed as another disincentive for physicians to participate and is unnecessary given the multitude of screening provisions already in place through licensure and credentialing requirements.

The cosmetic surgery tax places our federal government in the unique position of creating a national sales tax on medical services and studies have shown this type of tax disproportionately affects middle-class women.

Limiting the viability of physician-owned hospitals will reduce access to patient-centered, high quality care and will have a negative impact on the communities they serve. The criticism levied against physician-owned hospitals is clearly motivated by a desire to eliminate competition. More importantly, much of it has proven to be false. They achieve some of the highest quality scores and studies have proven they do not negatively impact community hospitals. There exists a certain amount of hypocrisy when hospital CEOs argue that physicians should not own hospitals, while they themselves are buying physician practices in order to steer patients to their hospitals.

We understand the high stakes involved in moving this legislation forward and recognize that its impact will be felt for many years to come. We are committed to working with you to make this monumental effort something that will benefit Arkansans as well as our nation. We believe these changes are critical in reaching that goal. Please contact us in order to discuss how we can help you make these crucial improvements to the bill.

Sincerely,

Steven Strode, MD and David Jacks, MD