As this issue of The Hematologist goes to press, the U.S. Senate and House of Representatives are preparing for votes on health reform legislation. The legislation to overhaul the nation’s health-care system is constantly evolving: key congressional committees are advancing proposals, but battle lines continue to sharpen between Democrats and Republicans. Meanwhile, the major stakeholder interest groups — insurers, pharmaceutical companies, hospitals, physicians — spar over provisions involving the role of the federal government, who will be covered and who will cover them, and how we will pay for reforms.
ASH members likely have been following the debate and are familiar with the discussion concerning the development of a public insurance option, elimination of coverage denials based on pre-existing conditions, creation of an employer mandate, and other important issues. However, it may not be apparent to our membership how ASH has been representing hematology in this debate.
Over a year ago, the Committee on Government Affairs proposed major principles for health-care reform, which were approved by the Society’s Executive Committee. These principles provide a broad context for Society involvement and include support for universal access to affordable health care, evidence-based medicine, and continued federal investment in biomedical research. The complete principles can be viewed at www.hematology.org/Advocacy/Policy-Statements.
As the new Congress began discussing reform earlier this year, members of ASH’s Committee on Government Affairs and Committee on Practice drilled down further and visited congressional offices to discuss the need to maintain access to specialized hematology care. They made the following recommendations: Congress should maintain policies that ensure patients have direct access to hematologists, legislation must recognize the value of cognitive services and improve Medicare payment for these services, legislation should not establish policies that increase payment to primary-care services by reducing payment for cognitive services, and Congress should eliminate the Medicare Sustainable Growth Rate formula and provide physicians with an adequate annual update in fees.
By spring, congressional debate concerning health reform began in earnest, and there was significant congressional interest in addressing the increasing shortage of primary-care physicians. While ASH supports the concept of a primary-care bonus, the Society became concerned that the “budget-neutral” proposals under consideration would require any bonus to be financed through reductions in other services, including cognitive services.
Recognizing that this was a concern other cognitive specialties may share, ASH took the initiative to reach out to all of the internal medicine subspecialty societies to organize a joint advocacy strategy. Consequently, an ad hoc coalition of internal medicine subspecialty societies developed a proposal that would provide a bonus payment for evaluation and management (E/M) services provided to patients suffering from the chronic conditions already identified by the 2009 Medicare Special Needs Plan Chronic Condition Panel (SNCCP). By using a patient-centered approach to determine eligibility, all physicians treating patients with the chronic conditions identified by the SNCCP would be rewarded for the provision of care.
As of the beginning of July, nine physician groups and a growing list of patient advocacy organizations have shared this proposal with Congress. ASH has helped coordinate joint visits to key congressional offices. While the outlook for this specific proposal is not clear, this multispecialty-society effort has helped educate Congress about evaluation and management services and has helped increase the visibility of what our members and other physicians in heavily cognitive subspecialties do to treat patients. I encourage you to keep track of the health reform debate and ASH’s efforts through the Society’s Web site. Please do not hesitate to share your concerns and questions with the Government Affairs staff at grassroots@hematology.org.
