Published: 2009-08-04 21:31:10
Author: Emily P. Walker | MedPage Today | July 14, 2009
WASHINGTON, July 14 -- The House of Representatives' final healthcare reform bill includes a number of new rewards for primary care physicians as part of its package for extending health insurance to nearly all Americans.
Unveiled today after weeks of hearings, the bill's provisions include:
- Increased Medicare payments to primary care physicians by 5%
- An additional 5% pay boost for primary care doctors in designated "health shortage" areas
- A restructured formula for calculating Medicare reimbursements each year
- Enlargement of the National Health Service Corps by "an amount sufficient to eliminate 40% of the estimated shortfall in primary care providers"
- New scholarships for medical students who choose primary care as a specialty
The bill -- which runs to more than 1,000 pages -- would expand coverage to 97% of all Americans, leaders of the House told reporters during a Tuesday press briefing. They said a cost estimate from the Congressional Budget Office (CBO) is still forthcoming.
Lawmakers didn't tamper with many of the original measure's hallmark elements during its transition from draft to formal bill.
It would still create a government-run insurance plan to operate alongside private plans, it would still require most employers to provide insurance for their employees, and it would still require individuals to purchase insurance.
The final bill also ditches the sustainable growth rate (SGR) formula for setting physician reimbursements in Medicare, as in the draft. (See It's Official: House Healthcare Reform Bill Scraps SGR).
Every year, the SGR formula calls for cuts in most reimbursement rates, and every year, physician groups plead for Congress to override it. So far, they've been successful.
Without legislative action this year, physicians would face a 21% reimbursement cut in 2010 and an additional 6% annual decrease for several years thereafter, according to the SGR formula.
The bill would stave off the impending cut and instead set reimbursements to reflect inflation, not the SGR.
In the longer term, physician payment updates would be calculated separately for different billing codes, instead of lumping together overall spending, regardless of specialty, as the SGR system does.
By including high-cost procedures, such as radiation treatments, in the SGR's across-the-board payment update, the overall price paid for "physician services" increases, and all doctors, even primary care physicians, are tagged with that cost.
New billing codes for "evaluation and management," and "prevention" would be added under the reform package, ostensibly to boost payments to primary care physicians who aren't currently reimbursed for discussions with patients.