By Nancy Berliner, MD, ASH President
2009-09-01
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.
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