Legislative and Regulatory Updates

Health Care Reform Draft Legislation Released in U.S. House of Representatives
Draft legislation to reform the nation's health care system was released in the U.S. House of Representatives by the three congressional committees that have jurisdiction over health care issues. The draft legislation, totaling over 850 pages, provides for a public plan health coverage option that will compete with other insurers in a national health insurance exchange, expands the Medicaid program and provides subsidies to individuals earning up to 400% of the federal poverty level for the purchase of insurance.

Some of the provisions of particular interest to AACE members are the following: 1) Repeal of the current Medicare Sustainable Growth Rate (SGR) physician payment formula. The current formula is replaced with a positive update based on the Medicare Economic Index in 2010, and then beginning in 2011, separate volume targets will be created for two categories of services (1. primary care, E&M, preventive care, and 2. all other services); 2) Incentives to form accountable care organizations, medical homes, and reduce hospital readmissions; 3) An increase the utilization rate - or assumption about the time in use - for all imaging services from 50% to 75%. This last proposal will affect the calculation of the practice expense for imaging services and result in a reduction in reimbursement; 4) An emphasis on prevention and wellness including a prohibition of cost-sharing for preventive services in benefit packages; 5) "Physician Payment Sunshine" provisions that require manufacturers and distributors to report payments to all types of healthcare providers. The language in the House bill is considered much more onerous than the Senate version of these provisions championed by Senator Grassley.

The legislation does not specify how the reforms will be paid for but lists several potential options including additional payroll taxes, tax exclusion caps on health benefits and new taxes on sweetened beverages and alcohol. The House Committees plan to hold hearings on the bill and begin marking-up the legislation following the July 4th congressional district work period. To read the draft legislation or summary papers on specific issues, please click here.

Protect Patient Access to Osteoporosis Diagnosis, Prevention and Treatment Services
The Medicare Fracture Prevention and Osteoporosis Testing Act of 2009 (H.R. 1894/S. 769) has been introduced in Congress. H.R. 1894 was introduced by Representative Shelley Berkley (D-1st-NV) and Representative Michael Burgess (R-26th-TX) with 64 members of the House of Representatives joining them as original co-sponsors. Senator Blanche Lincoln (D-AR) and Senator Olympia Snowe (R-ME) were joined by Senator Dianne Feinstein (D-CA), Senator Debbie Stabenow (D-MI) and Senator Sheldon Whitehouse (D-RI) in introducing S.769 in the U.S. Senate. The legislation protects access to osteoporosis prevention, diagnosis and treatment services conducted with a dual energy x-ray absorptiometry (DXA) machine...more

Replace the Current Flawed Medicare Sustainable Growth Rate (SGR) Formula
The Medicare Payment Advisory Committee (MedPAC) reports that 30% of Medicare patients have trouble finding a new primary care physician. This problem will only worsen if the current Medicare physician payment rates continue to be determined by the flawed Medicare Sustainable Growth Rate (SGR) payment formula. AACE urges Congress to end the cycle of addressing steep Medicare physician payment cuts with temporary fixes and replace the current flawed system based on the Sustainable Growth Rate formula (SGR) with a payment system that reflects increases in practice costs...Learn More

DXA Study Findings
AACE, along with our sister societies, recently commissioned a study by The Lewin Group to determine the cost of performing a DXA and VFA procedure in the physician office setting. The study also looked at program costs associated with reversing Medicare payment cuts for these procedures. The Lewin Group study concluded that restoring DXA payment rates to the 2006 level will save the Medicare program $1.14 billion over five years due to early diagnosis and the prevention of fractures. Click here to read the executive summary or the complete report.