Policy

Today, House Speaker Nancy Pelosi, D-CA, unveiled H.R. 3962, the Affordable Health Care for American Act, which seeks to address the uninsured by including a public option that would allow the HHS secretary to negotiate payment rates with providers and not base them on Medicare rates. The House bill would include an individual and employer mandate for health insurance, and expand subsidies to help individuals and small businesses purchase insurance.

Key provisions in the legislation that impact gastroenterology:

• CRC Screening Deducible Waiver — corrects the current Medicare CRC screening deductible waiver where the deductible is waived regardless of whether or not a polyp or lesion is found and needs to be removed. Currently, the deductible is not waived if a polyp or lesion is found, which is confusing for both Medicare beneficiaries and physicians. The AGA has been working with the Ways and Means Committee staff for the past few years to include a technical correction to the deductible waiver.
• Cost Sharing — waives cost sharing for Medicare-covered preventive services, including CRC screening, which will also provide additional incentives for individuals to be screened.
• Physician Quality Reporting Program (PQRI) — implements a mechanism to provide timely feedback for physicians, establishes an appeals process, integrates the PQRI and electronic health records reporting, and extends incentive payments to physicians to encourage reporting. AGA has been advocating for these changes.
• Misvalued Codes — gives the secretary authority to review codes which have not been subject to review since the implementation of the resource-based relative value system, the so-called “Harvard-valued codes,” which include many gastroenterology services.
• Ambulatory Surgery Centers (ASCs) — requires ASCs to submit cost and quality data.
• Sunshine Provisions — requires physicians, pharmacists and pharmacies, health insurers and health plans, hospitals, medical schools, sponsors of CME programs, biomedical researchers, and patient advocacy and disease groups to report payments received from pharmaceutical companies of a $5 value. This includes drug samples, which would be reported but not made public.
• Imaging — requires a 75 percent rate of utilization for all physicians who own imaging equipment and would apply to only MR, CT and PET. This could have an impact on gastroenterologists who plan to use CT in the future.
• Patient-Centered Medical Home — expands the medical home model, but does not exclude specialists from becoming a medical home if they so choose, since it specifies “principle care provider.” Therefore, a gastroenterologist could serve as a medical home provider if they choose.
• Graduate Medical Education (GME)/Indirect Medical Education (IME) — allows for the redistribution of unused residency slots and positions from closed hospitals. Alters the GME and IME requirements to allow for non-hospital settings if the hospital incurs the costs, along with an Office of Inspector General study on these changes. Provides a demo for “qualified teaching health center” (federally qualified health center or rural health center) to receive graduate medical education payments. Creates new rules for counting resident time in didactic and scholarly activities.
• Workforce Strategy — creates a new scholarship and loan repayment program for individuals who are seeking or have a degree “in a health field, as deemed appropriate by the secretary” in which 90 percent of the funds go to primary care clinicians. Makes a whole series of changes related to primary care, dental care, nurses, public health and minority students as part of the title VII and VIII reauthorization process. Authorizes an advisory committee to examine health workforce issues and the National Center for Health Care Workforce Analysis at Health Resources and Services Administration.
• Comparative Effectiveness Research — creates a new center at the Agency for Healthcare Research and Quality (AHRQ) to study the “outcomes, effectiveness and appropriateness of health-care services and procedures.” Establishes a commission to oversee AHRQ’s activities, which appoints a clinical research advisory panel for each priority area. Requires an ombudsman and other means by which to obtain stakeholder input. The research must take into account the potential differences of various individuals. Requires public access and dissemination. Creates a public-private funding mechanism. Also contains protections to prevent the research from being used to make coverage and cost decisions.

Read the AGA statement of principles, "Reforming the Health-Care System," which summarizes AGA's position on several topics from physician reimbursement to the uninsured to health information technology.