• Vascular Specialist Newspaper
• Volume 5 - 2009
• Number 9 online
• Number 8
• Number 7 online
• Number 6
• Number 5 Online
• Number 4 online
• Number 3
• Number 2
• Number 12 online
• Number 1
• Volume 4 - 2008
• Number 6
• Number 5
• Number 4
• Number 3
• Number 2
• Number 1
• Volume 3 - 2007
• Number 6
• Number 5
• Number 4
• Number 3
• Number 2
• Number 1
• Volume 2 - 2006
• Number 6
• Number 5
• Number 4
• Number 3
• Number 2
• Number 1
• Volume 1 - 2005
• Number 2
• Number 1

Before the August 2009 recess, three House committees that have jurisdiction over health care, Energy and Commerce, Ways and Means, and Education and Labor, passed H.R. 3200, America's Affordable Health Care Choices Act of 2009. However, the last committee to pass the bill, Energy and Commerce, will likely consider some of the 71 amendments in September that have not been reviewed by the committee as yet. The following provisions have a direct impact on vascular surgeons:

• Physician Payment reforms the Sustainable Growth Rate (SGR) formula that is currently used to annually update reimbursement rates for physician services in Medicare and completely eliminates any projected deficits; in 2010, updates payment rates by using the Medicare Economic Index, which will provide at least a 1 percent increase. It does not reduce payment rates for increases in spending on drugs or lab services;
• AAA Screening requires the Health and Human Services (HHS) Secretary to report to Congress within 12 months on beneficiary barriers to AAA screening in Medicare and makes the education of physicians and patients about the risk factors for AAA and when beneficiaries should be screened a priority. It also eliminates beneficiary co-pays;
• Payment for Imaging Services increases the practice expense units for imaging services to reflect a presumed utilization rate of 75 percent instead of 50 percent, but excludes ultrasound from the adjustment;
• Physician Payments Sunshine Provisions requires manufacturers or distributors to electronically report to HHS any payments or other transfers of value above $5 to covered recipients, which include physicians, physician group practices, sponsors of continuing medical education (CME), and organizations of health care professionals. An amendment to remove CME sponsors and health care professional organizations from the recipients' list may be considered in September; It also pre-empts state sunshine acts.
• Comparative Effectiveness Research establishes a Center for Comparative Effectiveness Research within the Agency for Healthcare Research and Quality (AHRQ) to conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care services and systems. It also establishes a 17-member Commission that will include the AHRQ Director, Centers for Medicare and Medicaid Services Chief Medical Officer, clinicians, patients, researchers, third-party payers, and consumers;
• Payment Incentive for Selected Primary Care Services increases the Medicare payment rate by 5 percent for primary care services of physicians, which is defined by specialty and by share of a practice in primary care;
• Liability Reform provides incentive payments to states to encourage them to implement one or more medical liability litigation alternatives;
• Public Pl allows physicians to opt-out and prohibits taxpayer bailouts to subsidize the plan. Blue Dog (conservative Democrat) amendments that were adopted include:

1. Requiring the HHS Secretary to negotiate payment rates in the public plan. These cannot be lower than Medicare or higher than the average rate paid by private plans in the Health Care Exchange. The Exchange allows consumers to choose between public and private competing health insurance plans.
2. Establishing a Consumer Operated and Oriented Plan (CO-OP) program through which grants and loans will be made for the creation and initial operation of not-for-profit, member-run health insurance co-ops that provide insurance through the Exchange.
3. Making those who are offered insurance by their employers ineligible for subsidies in the Exchange unless their premiums equal 12 percent of their income. Small businesses with $500,000 or under in payroll would be exempt from the "pay-or-play" mandate.
4. Establishing a CMS Payment Innovation to test the effect of payment models on spending and quality of life under Medicare. The HHS Secretary may implement the model nationwide if it improves quality without increasing spending and/or reduces spending without reducing quality.

Society for Vascular Surgery (SVS) staff and members have been "at the table" with members of Congress and their staff to secure many of the provisions listed above. Also, SVS staff participates in weekly meetings with other surgical specialty representatives hosted by the American College of Surgeons and makes joint Hill visits with this group.

On the Senate side, the Finance Committee is scheduled to release its version of health care reform by September 15 and it is expected to be problematic for vascular surgeons. The following provisions are likely to be included in the Senate version:

• Only a 1 or 2 year "fix" to Medicare physician payment using the flawed SGR formula;
• An increase in power for the Medicare Physician Advisory Commission or a similar small commission that would be an unelected, unaccountable government body with minimal Congressional input.
• Additional cuts to imaging, with the possibility of inclusion of vascular ultrasound.
• No elimination of barriers to AAA screening, including the continuation of co-pays.

An automated health care reform letter to Senators is posted on the VascularWeb.org. On the bottom left of the home page click on the "Take Legislative Action" button and this will enable vascular surgeons to access the letter and email it to their Senators. Over 400 letters have been emailed to Senators, but many more letters are needed to get their attention. No other issue will have a bigger impact upon the future of vascular surgery. A sample letter is also presented on this page for your use.

In addition, SVS distributed a press release clarifying vascular surgeons' role in diabetic foot care in response to President Obama's remarks during an Aug. 11 health care reform town hall meeting. This was released through a wire service and received over 230 "hits" from reporters, which was the most in years.

Please view the press release reprinted on page 9 (opposite). SVS also signed onto a letter with 18 other surgical specialties on the President's remarks that was sent directly to the White House.

For additional information or questions, contact Pam Phillips, SVS Director of Health Policy and Government Relations, at pphillips@vascularsociety.org.

Download/View Sample Health Care Reform Letter to Send Senators