ASPS comments on physician payment reforms
The flawed Medicare sustainable growth rate formula (SGR) is once again slated to result in a statutory 25 percent cut unless Congress acts before Jan. 1. The AMA recently convened a panel of experts to study reforms to the system that could replace the SGR, and the Medicare Payment Advisory Commission (MedPAC) is hoping to release a new plan in the fall.
Many in Congress have stated their desire to completely repeal the SGR this year and create a new system, rather than simply patch the impending cut. However, some policy experts have suggested that the $330 billion price tag for repeal is a major obstacle for Congress.
ASPS was recently asked by the House Energy and Commerce Committee to comment on Medicare physician payment reform. ASPS advocated that the committee repeal the SGR and provide stable updates for a five-year transition period based on the medical economic index (MEI). ASPS encouraged the committee to implement a separate growth target during the transition for major surgery to alleviate the blunt cuts inflicted by the SGR on surgical procedures that aren't responsible for the growth rate. The Society also strongly advocated that the committee consider savings available from implementing comprehensive medical liability reform.
Read the complete letter from ASPS.
ASPS opposes legislation that undermines the RUC
Rep. Jim McDermott, MD (D-Wash.), recently introduced the Medicare Physician Payment Transparency and Assessment Act of 2011 (H.R. 1256), which would require the Center for Medicare and Medicaid Services (CMS) to annually review recommendations of independent contractors tasked with identifying misvalued Medicare physician services, and to determine how much physicians should be paid.
The Society recently signed a letter that addresses misconceptions about the composition and role of the Relative Value Scale Update Committee (RUC). The letter asserts the RUC's value as a multispecialty physician expert panel and outlines its purpose, which is to properly value specific services provided by physicians and other health care professionals. In addition, the letter addresses criticism from some that the RUC has a purported bias favoring specialty procedures that disadvantages primary care procedures. Given the authority already available to the CMS to accept, reject or modify the RUC's recommendations regarding the valuation of physician services, ASPS is opposed to proposals that would add further bureaucratic layers - including individuals who are unfamiliar with clinical practice - to the process of valuing services in the Medicare physician fee schedule.
ASPS opposes expansion of IPAB in president's budget
President Obama's recent budget proposal included provisions to strengthen the Independent Payment Advisory Board (IPAB) that passed as part of the health reform law. Under the new law, the IPAB is responsible for making recommendations on Medicare payment policies when Medicare growth exceeds a given target. When that happens, the IPAB must submit a proposal to reduce spending without reducing patient benefits, and Congress has limited ability to amend the proposal.
Because many sectors of health spending are exempt, the primary focus of the IPAB is likely to be on reducing physician reimbursements. ASPS believes these measures will ultimately hurt the patient by limiting access to physicians of their choice. ASPS vigorously opposes IPAB and seeks its immediate repeal. To that end, it recently joined colleagues in the Alliance for Specialty Medicine in responding to the president's IPAB proposal.
Read the Society's response.
On Capitol Hill
Medicare Patient Empowerment Act
Rep. Tom Price (R-Ga.), an orthopedic surgeon, introduced the Medicare Patient Empowerment Act (H.R. 1700) on May 4. This legislation would allow Medicare beneficiaries and physicians to freely contract - without penalty - for Medicare services. Patients would be compensated by Medicare for the eligible portion of the treatment, rather than under current law in which the beneficiary must pay the entire amount for health care services provided pursuant to a private contract. Additionally, physicians would no longer be excluded from the Medicare program for two years for entering private contracts.
State Legislation and Regulation
Medical taxes
Connecticut Gov. Dannel Malloy signed the state's budget on May 4, which includes a provision that would implement a tax on cosmetic medical procedures. ASPS and the Stop Medical Taxes Coalition are working with the Connecticut Society of Plastic and Reconstructive Surgeons and the Connecticut State Medical Society to have the tax provision eliminated, either in the implementation legislation or subsequent regulations.
On March 18, the Washington House introduced H.B. 2022, which would implement the state's sales-and-use tax on cosmetic medical services to cover Medicare Part D copayments. Earlier in the 2011 legislative session, Washington introduced H.B. 1847/S.B. 5816, which would also implement a cosmetic tax.
Damaging cosmetic tax legislation is still active in Minnesota (S.B. 671/H.B. 567) and Texas (H.B. 3367). ASPS is working with stakeholder groups to defeat these measures as well. ASPS members in Minnesota, Texas and Washington are encouraged to visit capwiz.com/sslac and click on the "Issues and Legislation" tab to access ready-made, customizable messages to send to lawmakers in opposition to these insidious taxes.
Scope of practice: Dentistry
The New York Senate committee on Higher Education has reported SB 3059 favorably out of committee. This legislation would expand the dental scope of practice to allow non-physician oral surgeons to perform cosmetic surgical procedures. New York currently has model language in statute that appropriately limits the dental scope of practice to procedures and treatment of conditions related to oral health. SB 3059 creates a loophole allowing oral surgeons with hospital privileges to perform cosmetic surgical procedures in their offices. ASPS is urging New York members to contact their lawmakers to oppose this legislation.
On April 13, ASPS registered opposition to Alabama S.B. 214, which would expand the dental scope of practice to allow dentists to write prescriptions for Botox® and other dermal fillers. ASPS is opposed to this and any legislation that would allow dentists to perform cosmetic medical procedures. ASPS registered its opposition in a letter to the chairman of the Senate Health Committee, where the bill is currently awaiting consideration.
The Louisiana State Board of Dentistry conducted a public hearing on April 1 concerning proposed rules to expand the scope of practice of dentistry to include the use of Botox and dermal fillers. The Board deferred its decision until a May 20 meeting, at which time the Board will review public comments. ASPS registered its opposition to dentists engaging in the unlicensed practice of medicine in a March 22 letter to the Board of Dentistry.
Arizona Gov. Jan Brewer signed H.B. 2530 on April 26, which redefines dentistry in the state to include surgical treatments for any disease, pain, deformity, deficiency, injury or physical condition of the human tooth or teeth, alveolar process, gums, lips, cheek, jaws, oral cavity and associated tissues. In 2002, Arizona passed scope-expanding dentistry language that enabled oral surgeons to lawfully perform cosmetic surgery. While the bill would not substantively change the state's already expansive statute regarding dentistry, ASPS registered its opposition to nonphysician oral surgeons engaging in the practice of medicine, in a letter to the House Health and Human Services Committee.
Truth in advertising
ASPS member surgeon Michael Edwards, MD, on April 11 testified before the Nevada Senate Committee on Commerce, Labor and Energy regarding legislation (S.B. 367) that would require health care providers to disclose the type of license under which they are operating, their highest academic degree and their medical specialty-certifying board information. The bill received a unanimous vote out of committee and then cleared the Senate on April 25. At PSN press time, the bill was slated to be heard in the Assembly Commerce and Labor Committee on May 9.
Members of the Louisiana Society of Plastic Surgeons are championing similar "name your board" legislation (S.B. 152). This legislation would allow physicians who use the term "board certified" only after meeting very specific criteria and by stating the full name of the approved medical specialty-certifying board. On May 3, ASPS member Debra Ann Reilly, MD, testified to the Senate Commerce, Consumer Protection and International Affairs Committee in support of S.B. 152, which subsequently received a favorable vote. S.B. 152 was passed unanimously (37-0) by the Senate.
ASPS registered support for legislation in Minnesota (S.B. 707/H.B. 1225) on April 26 that, among other elements, would require physicians to disclose their specialty-board certification in any advertising efforts. The bill also stipulates that an elective cosmetic surgery procedure not be performed on a patient unless the patient has received an appropriate physical examination and written clearance from a licensed physician, a certified nurse practitioner or a licensed physician assistant.
Over the 2011 legislative session, 20 states introduced truth in advertising bills. These bills would provide a variety of protections to ensure patients understand the qualifications of their treating health care provider. Tennessee and Utah have also passed such measures. ASPS supports transparency in health care provider advertising and will continue to encourage state medical associations to advocate for physician-specific disclosures regarding medical-board certification in any legislation that is being considered this session.
Supervision
A Colorado Judge has upheld a decision that allows nurse anesthetists to administer anesthesia without physician supervision. A Denver district courts judge ruled that former Gov. Bill Ritter's decision to opt-out of the federal Medicare rule that requires physician supervision of nurse anesthetists while administering anesthesia is consistent with state law. The Colorado Medical Society along with the Colorado Society of Anesthesiologists filed suit to overturn the decision, claiming that the administration of anesthesia by a CRNA without physician supervision was outside the nursing scope of practice. Fifteen states have opted-out of the federal rule, most frequently citing the need to increase access to care in rural areas.
Office-based surgery
California S.B. 100, which would have required all physician-owned surgical facilities to be licensed by the Department of Public Health (DPH), was favorably amended on April 25. The California Society of Plastic Surgeons has been working with the bill's author to ensure physicians' offices would not be negatively impacted by the bill.
On March 21, Iowa Senate File 480 was favorably amended to remove a provision that would have imposed a certificate of need (CON) requirement for physician-owned office-based surgery suites. ASPS partnered with the Iowa Society of Plastic Surgeons and the Iowa Medical Society to activate a successful grassroots communication campaign in opposition to the CON requirement.
Legislation (A.B. 7431/S.B. 4597) introduced in New York in late April would mandate that every facility operating as an office-based surgery practice must hold a certificate of registration. The legislation further stipulates that every accredited office-based surgery facility shall receive payment from a health care plan for the use of the facility, in addition to the professional fee charged by the licensee for the covered office based surgery procedure. A similar bill (A.B. 7185/S.B. 396) is also under consideration in New York. ASPS supports legislative and regulatory solutions to the problem of insurance carriers not providing payments for the facility fees associated with office-based surgical procedures.
The Tennessee House Committee on Health and Human Resources on April 5 deferred action on H.B. 977, a bill designed to extend facility licensure requirements to physician offices in which cosmetic medical procedures are performed. ASPS is working with the Tennessee Medical Association and other stakeholders in medicine to develop legislative language that addresses the Legislature's concerns regarding patient safety in medical spas, without imposing burdening requirements on physicians.
Medical liability reform
The Virginia House on April 6 voted to override Gov. Robert McDonnell's veto of S.B. 771/H.B. 1459. Supported by the Medical Society of Virginia, the bill would set the medical malpractice cap at $2.05 million with annual increases of $50,000 until 2031. That same day, the South Carolina Senate introduced S.B. 772, which would limit noneconomic damages caused by a licensed physician or dentist at $350,000.
Patient education
The Ohio House on May 3 introduced H.B. 217, which would mandate that patients be informed of their reconstructive surgery options following mastectomy surgery, lymph node dissection or lumpectomy procedures, including the availability of coverage for reconstructive surgery.
On April 7, New Mexico Gov. Susana Martinez signed S.B. 283, which requires patients be informed of their reconstructive surgery options. Similar measures are still being discussed in Texas (S.B. 669) and Washington (S.B. 5262/H.B. 1101). ASPS is supportive of these proposals, as several recent studies have demonstrated that the majority of breast cancer patients are not informed of the options available to them.
Insurance
The New York Assembly on April 15 introduced A.B. 7193, which would bring state law into accordance with the federal Women's Health and Cancer Rights Act by requiring insurance providers to cover reconstructive surgery after a partial mastectomy or lumpectomy. A.B. 7193 is currently being considered in the Assembly Committee on Insurance. The New York Senate introduced its companion version (S.B. 3801) in early March.
Implementation of health reform
The Vermont Senate and House on May 3 passed H.B. 202 which would make the state the first with a single-payer health care system. H.B. 202 would implement a universal health care program that would provide health benefits through a single payment system by 2017. Gov. Peter Shumlin is expected to sign the legislation.
Physician competence
The North Carolina Medical Board on March 29 adopted a new position statement on physician scope of practice. It discourages physicians from practicing outside areas in which they were trained, and it notes that physicians intending to expand their practice to an area outside of their graduate medical education should ensure that they have acquired the appropriate level of education and training. ASPS will continue to monitor the issue on both the regulatory and legislative levels.
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