Government Relations recap: 'Health Care Reform in the 112th Congress'
Speaking to a capacity crowd at Marshfield Clinic's Froehlke Auditorium on January 13, the Clinic's federal Government Relations director gave a recap of the 2011 Congress in his annual Grand Rounds talk.
Amid a backdrop of political gridlock, growing debt, health care reform issues and "living the presidential primary theater," Government Relations Director Brent Miller underscored that we do indeed live in interesting times.
Disenchantment with Washington is at all-time high, he said, with the approval rating of Congress dropping to 11 percent. "One bright note is that Congress did pass the 2011 budget."
The Clinic continues to actively promote its health care agenda at the state and federal levels. "Marshfield Clinic is a real relevant player. We are doing some really incredible things" to help shape national health policy, Miller noted, citing our successes with dental access to rural populations, the Physician Group Practice (PGP) Demo and Biomedical Informatics.
Despite the political dissention and impasse over the past year, the Clinic has worked with Congressional leaders on a number of health care initiatives. Its agenda includes:
- Value-based purchasing (which links payment more directly to the quality of care provided) for Medicare & Medicaid
- Supporting Security Health Plan's Growth in Medicare Advantage and BadgerCare Plus
- Electronic medical record funding as part of the ARRA Recovery Act
- Federal/state health care reform - universal coverage
- Community Health Centers funding - urging access to care, including dental
- Medicare payment fairness - including annual physician payment updates
- Supporting comparative effectiveness research
- Opposing Medicaid block grants without changes
- Opposing Medicare premium support without changes
Health care organizations face critical payor mix issues, with 25 percent of Medicare beneficiaries incurring 85 percent of the costs for health care. Adding to the dilemma is the surge in Medicare users. The federal government reports that 10,000 people will be turning 65 each day for the next 20 years. (In 1975, The country had 24 million Medicare recipients, compared to a projected increase to 88 million by 2040).
Citing a 2008 Commonwealth Fund survey, 45 percent of Americans reported failures in their health care coordination - ranging from miscommunication between their primary care provider and specialist, to not having medical records/test results ready at the appointment to having inadequate follow-up on medical care after the exam. Miller said the Clinic's favorable care coordination efforts are paying off in enhanced care and reduced costs, saying it's "one of the most important things we can do to reduce health care issues."
Brent Miller, Clinic federal Government Relations director, makes a point about challenges in the roll-out of health care reform legislation during the annual recap of the year in Washington, D.C.
He referred to the HR 3630 Middle Class Tax Relief & Job Creation Act and its "work geographic adjustment" for medical providers. Before, procedures were costed out at different rates in different geographic areas, resulting in rural and small town providers not being paid on par compared to larger metro area providers. This disparity is now being re-examined. The Medicare Payment Advisory Commission must issue a report by June 12 that assesses whether any geographic adjustment is needed.
Looking ahead to the big picture of the Affordable Care Act of 2010, Miller said debate will continue on health insurance reforms, Medicaid expansions, Medicare cuts and delivery system reforms along with mandates for individuals to purchase and employers to provide insurance.
"One of the most important elements to come out of the Institute of Medicine was a recommendation to go to a value-based payment modifier," Miller said. The Affordable Care Act of 2010 requires that under the Physician Fee Schedule, Medicare begins using differential payment to physicians, or groups of physicians, based on the quality of care furnished compared with cost.
The Affordable Care Act faces its biggest legal challenge when the constitutionality of the law is argued before the U.S. Supreme Court. At issue - Can Congress require people to buy private health insurance? Several district and appeals courts have ruled the mandate is constitutional while others have found that it is not. Supreme Court hearings will take place March 26-28, with a decision expected in June.
As roll-out of the health reform law continues over the next several years, Miller predicts significant challenges because of the differences in language and long timeframes for implementation. "That being said, the Clinic is still way ahead of the game in reducing health care spending. And that's a good thing."
Noting that Miller "did a great job of reviewing the events of health care reform and upcoming critical dates," Clinic Vice President and Goverment Relations Director Douglas Reding, M.D., M.P.H., FACP, said that health care reform will continue to evolve. "Patients are telling us they cannot afford health care. Marshfield Clinic must be attentive to our patient’s concerns while positioning the organization to respond to these changes."
