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Concerns surrounding HR 3590

Although the Patient Protection and Affordable Care Act will enable many more Americans to purchase and keep their health insurance, several of its provisions do not correspond to the AAOS “Principles of Healthcare Reform and Specialty Care.” In particular, the AAOS believes that the following issues are problematic and need to be addressed.

  • HR 3590 creates a Medicare Advisory Board that is not accountable to anyone except the president. Under this provision, an unelected body would have the authority to make policy and payment decisions about the Medicare program without sufficient checks, balances, and oversight from elected Members of Congress.
  • HR 3590 does not reform the flawed physician reimbursement formula under Medicare. With practice costs continuing to rise in the face of devastating cuts due to the Medicare Sustainable Growth Rate (SGR) formula, many physicians can no longer afford to stay in practice or to accept Medicare patients. By not repealing and replacing the flawed physician payment formula, this legislation severely threatens seniors’ ability to access timely and appropriate care from their physicians.
  • HR 3590 mandates participation in the flawed Physician Quality Reporting Initiative (PQRI). This program is still experiencing significant problems in providing accurate, actionable feedback to physicians and has not demonstrated an ability to improve the quality of care provided to patients. Furthermore, a mandatory and punitive approach would increase the already high cost of defensive medicine.
  • HR 3590 permits demonstration projects for direct access to physical therapists. The Innovation Center—a new, unaccountable government entity focused primarily on cost-reduction rather than value and efficiency in the delivery of care—within the Centers for Medicare and Medicaid Services would be empowered to conduct a demonstration project that would allow physical therapists direct access to Medicare patients. Current Medicare law requires a physician to authorize the type, amount, and duration of physical therapy and other healthcare services furnished to a patient. These laws protect patients and ensure that appropriate, timely treatment is given by the most qualified provider—their physician.
  • HR 3590 would restrict physician hospital ownership. The current language would prevent physicians from owning hospitals in this country in the future. Physician owners in physician-owned hospitals have greater control over the facility, the quality, and the efficiency of care (such as scheduling of surgeries, surgical equipment, and staffing) that lead to higher quality patient care. Furthermore, these facilities tend to have greater patient satisfaction, reduced costs, and lower infection rates.

The AAOS believes that physician-owned hospitals are an important component of the healthcare delivery system and that it is a disservice to patients to eliminate these successful partnerships.

  • HR 3590 does not address medical liability reform adequately. Meaningful medical liability reform at the federal level and/or constitutionally sustainable state medical liability reforms must be components of any viable healthcare reform proposal. Absent liability reforms, billions of dollars will continue to be wasted on defensive medicine, driving up the cost of health insurance.

AAOS Now
April 2010 Issue
http://www.aaos.org/news/aaosnow/apr10/cover1-2.asp

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