The Committee on Practice convened its spring meeting and Capitol Hill Day on May 4 and 5, 2009, in Washington, DC. The Committee first received a detailed update on the status of health-care reform initiatives, including, potential new approaches to physician payment, such as the patient-centered medical home (see Pages 1 and 7 to learn more about this), episode-based payments, and accountable care organizations. Among the challenges to physicians are infrastructure costs for private practitioners, the bundling of hospital/outpatient physician payments, the inadequacy of payment for cognitive specialists, and the insufficiency of measures of quality and outcomes that accurately reflect the performance of individual physicians in outpatient settings. Health-related provisions of the $789 billion American Recovery and Reinvestment Act (ARRA), including $21 billion for health-related information technology (HIT) and $1.1 billion for Comparative Effectiveness Research (CER), were reviewed. Physicians and hospitals that engage in meaningful use of HIT may be eligible for Medicare or Medicaid incentives in 2011 and subject to penalties by 2014 for not using HIT. President Obama’s $3.6 trillion fiscal year 2010 budget proposal also was summarized, including the proposed $630 billion health-care reserve fund to be collected over 10 years from new revenues and savings. The budget proposal did request $329.6 billion to address the scheduled Medicare physician payment cuts of 40 percent over the next seven years and asked for change of the sustainable growth rate (SGR) model. ASH and other physician groups have explained the problems associated with the annual proposed payment cuts that the SGR imposes, and consequently, the Committee on Practice is very pleased about the commitment to address the issue.
The Committee began its Hill Day by meeting with the staff of Sen. Kay Bailey Hutchinson (R-TX) and Sen. Edward Kennedy (D-MA) to discuss and support S.717 “21st Century Cancer Access to Life-Saving Early Detection, Research, and Treatment Act (ALERT). This bill was introduced on March 26 and has now been referred to the Committee on Health, Education, Labor and Pensions. The clinical trials component of this bill has become controversial. The Committee on Practice strongly advocated for that component to remain in the bill, however, and provided the Senators with arguments supporting the contention that access to clinical trials for all patients is part of the fabric of excellent clinical care.
In visits with Representatives, Committee members encouraged them to co-sponsor the Bone Marrow Failure Disease Research and Treatment Act (HR 1230), which was introduced to this Congress by Rep. Doris Matsui (D-CA) on February 26, 2009. This legislation directs the Health and Human Services Department to establish a national bone marrow failure registry. It supports pilot studies by the Agency for Toxic Substances and Disease Registry to better identify environmental factors causing bone marrow failure. Other measures aim to enhance access to treatment and clinical trials for disadvantaged patients and to authorize the Agency for Healthcare Research and Quality to improve diagnostic practices and quality of care for patients with acquired bone marrow failure conditions.
The central message about health reform that the ASH Practice Committee communicated to all Senators and Representatives was that any revisions of payment and policy should ultimately help and not impede patients who need care directly from hematologists. The Committee emphasized that patients inherit or acquire blood disorders that may be uncommon singularly but when considered collectively represent a major disease burden to our society - a burden evaluated and managed only by hematologists.
The Committee also emphasized that, while enhancing primary care by increasing payment for evaluation and management (E&M) by primary-care physicians is a positive policy goal, such an increase should also be extended to the E&M services performed by hematologists and not be at the expense of hematology subspecialty care. Hematologists provide significant primary care for a wide range of patients with chronic blood disorders, such as myelodysplastic syndromes, low-grade lymphoproliferative disorders, and sickle cell disease.
The Committee on Practice looks forward to updating members on the status of how these changes may affect hematologists at our 2009 Practice Forum in New Orleans. The Practice Forum will take place Saturday, December 5 at 6:30 p.m.
