The 2010 midterm elections brought about speculation that a GOP-controlled U.S. House of Representatives would take great effort to derail, or at least attempt to modify, the healthcare reform package. According to healthcare industry leaders, the latter appears to be more plausible, but not completely assured.
Anders Gilberg, the Medical Group Management Association's vice president for public and private economic affairs, reiterated that a bill challenging healthcare reform, even if it got through the House of Representatives, would not make it through the Senate. "And it certainly would not make it past the President's veto pen."
Rather, he projected that a tug-of-war would emerge with House Republicans attempting to repeal or revise certain portions of the new law. And in some cases, they would have the support of various provider-represented organizations such as MGMA, the American Medical Association (AMA) and others.
Among them is the sustainable growth rate (SGR) formula used by Medicare to calculate physician reimbursements. "The reason that MGMA, along with other provider organizations, couldn't support the final healthcare reform bill is related to the fact that the SGR wasn't repealed," according to Gilberg. "Physicians are facing a 25 percent cut in pay from Medicare."
Also at issue are is the independent payment advisory board (IPAB), a 15-member independent panel selected by the president and confirmed by the Senate that sets an upper limit on annual Medicare spending growth. It basically states that per capita Medicare spending will be limited to a formula based on general economic inflation combined with inflation in the healthcare sector until 2018 when the upper limit would be set permanently at per capita gross domestic product growth plus one percentage point.
AMA summed up its position in a statement released before the package became law: "The AMA is opposed to the current scope and authority of IPAB and the lack of flexibility in its mandate."
It may turn out that rather than repealing or modifying provisions of ACA, the greater struggle will be over money designated to fund certain programs outlined in Medicare payment revisions such as Accountable Care Organizations (ACOs) or the Center for Medicare Innovation.
"The real issue is whether or not the Republicans are going to use the power of the purse to de-fund or chose not to fund various agencies or programs that are not mandatory, but were simply authorized in the reform bill," Gilberg stated. This could prove problematic, however, in that they still have to find payment offsets for the provisions that the Congressional Budget Office determined would help to trim healthcare costs.
Organizations such as MGMA believe there is potential in programs such as ACOs, but are concerned about how many healthcare organizations will be able to make critical infrastructure investments required for participation. A recent MGMA study indicated that upwards of 75 percent of its members are scaling back capital expenditures for clinical and administrative systems in their practice.
"The struggle we have, which is really our advocacy priority, is to shore up the Medicare payment system before moving forward with some of the newer concepts," Gilberg said. "And the SGR is an impediment to any kind of reformed payment system."
See Also:
Major Cuts in Provider Pay Recommended by White House Commission