By Lawrence A. Solberg Jr., PhD, MD
2009-07-01
Dr. Solberg is Professor of Medicine in the Department of
Hematology/Oncology at the Mayo Clinic in Jacksonville, FL. Dr. Solberg
is also Chair of the ASH Committee on Practice.
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.
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