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House Democrats unveil first draft of healthcare reform plan.

Politico reports that Democratic leaders in the U.S. House of Representatives have released their draft of healthcare reform legislation. The bill creates a public insurance option, expands Medicaid, and requires employers to provide coverage or pay a tax. It also carries an individual mandate, with exception for cases of hardship. Those who are not covered by health insurance would pay a penalty based on 2 percent of their income above a certain level. The draft does not contain details on how to pay for the plan. Additionally, Rep. Henry Waxman (D-Calif.), head of the House Energy and Commerce Committee, stated that the House wants to find a permanent fix for the Medicare Sustainable Growth Rate reimbursement formula.
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Obama tells AMA: Liability is an issue but caps aren't the answer; reaffirms need for government plan.

Speaking June 15 at the annual meeting of the American Medical Association (AMA), President Obama said that he is willing to "explore a range of ideas" about ways to reduce the risk of medical liability lawsuits, but won’t support capping damage awards. He reaffirmed his stance on the need for a government plan option for the uninsured, and said that most of the cost of revamping the U.S. healthcare system can be recouped through more efficient medical record-keeping, paying physicians for results rather than procedures, and cutting back on reimbursements to hospitals for emergency room visits as more people are insured.

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An editorial published online in the New England Journal of Medicine examines the role of medical liability reform in reforming the U.S. healthcare system.
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Healthcare reform on congressional to-do list.

The Kaiser Daily Health Policy Report has gathered links to a number of stories on efforts in the U.S. Congress toward comprehensive health reform legislation in the wake of the presidential election. Recent updates include:

• A plan to develop and pass legislation based on President-elect Barack Obama's health care proposal to expand health coverage to more U.S. residents

• A white paper to be released next week by the chair of the Senate Finance Committee regarding specific policy issues and proposals seen as priorities for the newly elected Congress
• A proposal for expansion of the State Children’s Health Insurance Program
• A report that funds for state Medicaid programs that may be part of a new economic stimulus package

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New MedPAC recommendations include across-the-board transparency.

According to CQ HealthBeat, the Medicare Payment Advisory Commission (MedPAC) has reached agreement on a package of recommendations to Congress that would require broad disclosure by all manufacturers and distributors of drugs, biologicals, medical devices and medical supplies to report their financial relationships with physicians and other healthcare providers. Among other recommendations, MedPAC states that all entities that bill Medicare for services should be required to annually report the ownership shares of each physician who directly or indirectly owns an interest in that entity (excluding publicly traded corporations), and post that information on a searchable Web site.
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Major funding for orthopaedic trauma research comes through Department of Defense.

On September 30, 2008 President Bush signed the "Consolidated Security, Disaster Assistance, and Continuing Appropriations Act" (H.R. 2638). The measure includes the FY 2009 appropriations bills for Defense, Homeland Security, and Military Construction-Veterans' Administration and funds most of the remaining federal programs at FY 2008 levels through March 6, 2009. The bill includes $66 million for peer reviewed orthopaedic trauma research. The funding is a major success for orthopaedic trauma research and a direct result of the AAOS vision and lobbying efforts, according to Andrew Pollak, MD, chair of the extremity war injuries and disaster preparedness project team. During the past 2 years, $101 million in additional funding has been earmarked for orthopaedic trauma research. "Over the next few months we will continue to work with the Army to make sure these funds are used to stimulate the best possible research and to foster an environment that both improves clinical care for our injured warriors while supporting and stimulating the careers of orthopaedic clinician-scientists," said Dr. Pollak. "Our next steps will be to grow this program further to match levels of funding in the Department of Defense currently enjoyed by breast and prostate cancer research and to ensure that these programs are funded at appropriate levels in perpetuity."
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Senate to consider restrictions on imaging self-referrals

According to Modern Healthcare Online, Sen. Chuck Grassley (R-Iowa) is planning to introduce a bill that would require referring physicians to disclose any ownership interest they may have in an imaging service and to offer Medicare beneficiaries a list of alternative providers. The so-called Medicare Imaging Disclosure Sunshine Act of 2008 is based upon recommendations from the Medicare Payment Advisory Commission.

The AAOS supports appropriate disclosure to patients of physician ownership interest in ancillary services. The AAOS believes, however, that the increases in medical imaging utilization are driven by good patient care, and that patients' access to healthcare services may suffer if restrictions are imposed on physicians' ability to provide in-office imaging.
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EMTALA proposal would allow hospitals to share resources

American Medical News reports that the U.S. Centers for Medicare and Medicaid Services (CMS) has proposed adjusting its on-call policies under the Emergency Medical Treatment and Labor Act (EMTALA), which was designed to prevent emergency departments (EDs) from "dumping" uninsured or Medicaid patients at public hospitals. Under terms of the proposal, a group of hospitals in a particular region would have the option of designating one of the facilities as the on-call site for a specific time period, for a specific service, or both. Individual hospitals with EDs still would be required to screen each emergency patient and to have a plan for how to proceed if a needed on-call physician was not available. Some hospitals have complained that they are being stretched too thin trying to meet the demands for physician availability under the terms of EMTALA. The American Association of Orthopaedic Surgeons submitted a comment in support of this proposal on June 13, 2008.
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Congress pushing curbs on physician-owned hospitals

The New York Times reports on efforts in the U.S. Senate and House of Representatives to limit the spread of hospitals that are owned by physicians. On three occasions in the last 10 months, either the House or the Senate has approved legislation that would bar doctors from referring Medicare and Medicaid patients to hospitals in which the doctors have an ownership interest. None of the proposals have gotten all the way through the legislative process.Part of the problem is that influential senators and well-connected lobbyists are advocating for exemptions for a few institutions. The special treatment has drawn criticism from conservatives who oppose restrictions on physician-owned hospitals, and liberals who favor stringent rules with no exceptions.
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Proposal to Restrict Physician Ownership of Hospitals Fails

CongressNow reports that a proposal to restrict physician ownership of hospitals has been removed from a farm bill. The measure had been proposed as a way to offset the costs of the $280 billion subsidy bill. Opponents of the provision charged that the move infringed upon the jurisdictions of several congressional committees and that any proposed cuts in Medicare reimbursement should be used to pay for health care instead of offsetting agricultural spending. Opponents also disapprove of legislation that would also essentially ban the growth of physician-owned hospitals.

SCMA Files Prompt Pay Legislation

The SCMA has filed Prompt Pay legislation in the South Carolina Senate.  Senate Bill 974 was filed on February 10th and would provide physicians protection from many of the unfair business tactics of health insurers in South Carolina.  This language is similar to that passed in many other states and contains many provisions included in the legal settlements with the health insurers.

Please look for additional alerts on this legislation in the coming months.