ASPS joins chorus of opposition to GME cuts
ASPS and 18 other surgical groups sent a letter to President Obama on July 14 that expressed opposition to Medicare graduate medical education (GME) payment reductions that are included in the overall debt-reduction plan. The letter noted that a recent study by the Association of American Medical Colleges predicts a shortage of 130,600 physicians by 2025. Additionally, as the population grows and more baby boomers retire, the ratio of surgeons to patients is expected to decrease. The letter requests that Medicare reductions avoid cuts to GME in order to avoid exacerbating the physician workforce crisis. To view a copy of the letter, click on "ASPS Opposes Cuts to GME," on the "Key Issues in Plastic Surgery" page of the ASPS website. (Log-in to the Medical Professionals page at plasticsurgery.org and click on "Legislation & Advocacy" to access "Key Issues.")
Medicare, SGR discussed in debt ceiling negotiations
During debt ceiling negotiations in July, a variety of proposals were debated, including a proposal from the "Gang of Six" in the Senate that would have addressed medical liability reform and the Sustainable Growth Rate (SGR). ASPS supported the "Gang of Six" efforts to repeal the SGR and implement meaningful liability reform.
The final version of the debt-ceiling legislation doesn't include an SGR fix or medical liability reform, but it does include a trigger for Medicare spending cuts dependent upon the work of a bipartisan Congressional committee of 12. At this stage, it is currently unclear how this process will impact efforts in Congress to stop the 30 percent SGR reductions slated for January.
IPAB criticism grows among members of Congress
The House Budget Committee held a hearing July 12 on the Independent Medicare Payment Advisory Board (IPAB), during which Chairman Paul Ryan (R-Wis.) sharply criticized the board by calling it "a dramatic policy error that will fail to deliver meaningful reform to the Medicare program." Additionally, Rep. Allyson Schwartz (D-Pa.) testified that IPAB should be repealed.
The Patient Protection and Affordable Care Act of 2010 (PPACA) created the IPAB as an independent board that will monitor Medicare expenditures and make recommendations to reduce Medicare costs without reducing patient benefits. If Congress doesn't act on the IPAB recommendations within a set amount of time, they automatically become law.
IPAB was also discussed in a July 21 hearing of the Senate Special Aging Committee. Sen. Mark Kirk (R-Ill.) expressed concerns that the IPAB would ultimately have the power to deny medicines or procedures that could prove helpful to patients who need them.
Legislation has been introduced in both the House and the Senate (H.R. 452 and S.B. 668) that would repeal the IPAB. H.R. 452 currently has 190 cosponsors and S.B. 668 has 31 cosponsors. ASPS has endorsed both measures.
ASPS submits comments on shared savings/ACO Rule
A letter sent by ASPS to the Centers for Medicare and Medicaid Services (CMS) on June 3 asks for revisions to the proposed Medicare Shared Savings/Accountable Care Organizations Program. CMS was mandated by the Patient Protection and Affordable Care Act of 2010 (ACA) to establish such a program by Jan. 1.
The program is being designed to promote accountability for beneficiary care, and coordinate items and services provided to beneficiaries under Medicare Part A and B. A variety of provider groups are eligible to become ACOs, including physician group practices, hospitals with employed physicians, and joint ventures between physicians and hospitals. Although ASPS supports the ACO program's charge to provide better care for individuals, better health for populations, and lower growth in expenditures by eliminating waste and inefficiencies, the Society expressed concerns that the current proposal is unworkable and provides inadequate financial incentives to encourage widespread participation.
Given the substantial start-up costs for ACOs and potential fee-for-service revenue loss, ASPS is concerned that an ACO will not achieve the necessary savings, much less recoup its up-front investment. ASPS also opposes any provision to force ACOs to accept financial penalties as a stipulation for participation. In addition, ASPS commented that the requirement to report 65 quality measures is unrealistic, and that retroactive assignment of beneficiaries to an ACO will threaten the patient-physician relationship and limit an ACO's ability to focus on performance improvement.
Under the current proposal, specialists are permitted to join more than one ACO - a provision that ASPS supports. However, it's generally difficult for individual physician practices to participate, and the regulations favor hospitals versus physician-led ACOs. Therefore, ASPS urged CMS to make it easier for physicians to participate and recommended that CMS provide a payment option that includes shared savings without the mandatory shared-loss provision. The Society also suggested that an interim final rule should be issued to allow flexibility to adapt the program over time as needed.
In an attempt to better inform the development of the Shared Savings program, CMS recently released a Notice of Request for Applications for Pioneer ACO Models with applications due Aug. 19, 2011. The so-called Pioneer ACO Model creates an ACO option for more advanced systems and organizations already experienced in coordinating care for a population under risk sharing contracts who will be able to more rapidly transition to an ACO model. The Pioneer model includes specialty attribution and substantial quality performance incentives. The minimum number of beneficiaries is 15,000.
ASPS will continue to monitor this issue with interest. To view the ASPS comment letter to CMS, log-in to the Medical Professionals section of the ASPS website, enter "Legislation & Advocacy," click on "Key Issues in Plastic Surgery," followed by "Medicare Payment." Once inside, click on "Comments to Medicare on Shared Savings/ACO Proposal."
STATE LEGISLATION AND REGULATION
Truth in advertising
Louisiana Gov. Bobby Jindal on June 29 signed legislation (S.B. 152) that requires physicians who use the term "board certified" to do so only after meeting very specific criteria - and by stating the full name of the approved specialty medical certifying board. The bill became effective Aug. 15. ASPS worked with the Louisiana Society of Plastic Surgeons and other medical specialties to support the bill.
Office-based surgery
Legislators in New Jersey are considering proposals (S.B. 2780/A.B. 4099) that would require one-room office-based surgical (OBS) practices to be licensed as ambulatory care facilities by the Department of Health and Senior Services. The Assembly bill includes a provision that would exempt existing OBS facilities with one O.R. from the state's facility assessment and physical plant requirements.
The Senate version was amended in June to exempt existing one-room OBS practices from the facility assessment. The amendment also created an exemption from physical plant and functional requirements for one-room OBS practices that are certified as ambulatory surgery center providers by the Centers for Medicare & Medicaid Services. For non-certified surgical practices, the amended bill provides for a waiver by application of those requirements to be determined by the commissioner. S.B. 2780 passed the Senate on June 29.
ASPS is working with the New Jersey Society of Plastic Surgeons to favorably influence the debate.
Informed consent
Missouri Gov. Jay Nixon on June 30 signed legislation that changes the state's informed-consent communication requirements for patients seeking breast augmentation. The passage of H.B. 388 is a victory for the Missouri Association of Plastic and Reconstructive Surgeons, which viewed H.B. 388 as a top priority this year. Missouri plastic surgeons are currently required to provide and print at their own expense a 264-page informed-consent document to every potential breast implant patient. The new law took effect Aug. 28.
Medical spas
Massachusetts legislation that would implement restrictions on the Commonwealth's medical spas was heard in the Joint Committee on Public Health on July 12. Among other provisions, S.B. 1140 would require a clinical director (physician or nurse) to be physically present in the medical spa for at least 10 percent of the hours of operation each month; that all medical spa facilities register with the Department of Public Health within 120 days upon enactment; and that owners/operators submit an application for licensure within one year of enactment.
ASPS submitted comments in opposition to the bill, which was not acted on following the hearing.
The New Jersey Assembly on June 23 passed legislation (A.B. 3838) that would require the New Jersey Board of Medical Examiners to promulgate rules restricting the cosmetic use of Botox® in persons 18 years of age or younger.
Scope of Practice: optometry
The Kentucky Board of Optometric Examiners in August conducted a hearing as part of the rule-making process following the enactment of optometric scope of practice expansion legislation (S.B. 110) earlier this year. ASPS and other stakeholders in medicine provided comments in opposition to the rule. S.B. 110 allows optometrists to perform surgery using a scalpel or laser, among other things.
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