Climbing the Hill: Derms face off with nation's leaders on healthcare reform

September 1, 2009

At press time, lawmakers were still inching toward meeting a Sept. 15 deadline set by the Senate Finance Committee to reach a bipartisan compromise on healthcare reform. Dermatologists from across the country were expecting to be on Capitol Hill that day to let lawmakers know face-to-face their concerns about this sweeping legislative initiative.

Key Points

"There's nothing more important on our academy's plate than healthcare reform and our commitment to help achieve a positive outcome for dermatologists and their patients," says David M. Pariser, M.D., president of the American Academy of Dermatology Association (AADA).

"We've put together a knowledgeable group of people to evaluate these proposals ... and our message is that we will do everything we can do to support the practice of dermatology and our patients," he says.

'Positive step forward'

AADA wrote to committee leaders in the House of Representatives on July 20 to express support for "America's Affordable Health Choices Act of 2009," which was approved by the House Ways and Means, Energy and Commerce, and Education and Labor committees.

AADA said the House bill takes "a positive step towards eliminating the SGR altogether, eliminates the draconian payment cuts facing physicians, and with it, the need for annual short-term fixes to the Medicare physician payment system, which threatens patient access to quality dermatologic care."

That solution, which would be funded by the government without requiring offsetting reductions elsewhere or additional tax revenue, is estimated by the Congressional Budget Office to cost $245 billion over the next 10 years, and it is not included in the more than $1 billion price tag for the legislation.

AADA's letter also noted that the House bill would "bolster primary care services without exacerbating issues with specialty care." Translation: The bill would provide increases for primary care Medicare providers and general surgeons without forcing compensating reductions on specialists and subspecialists, as has been proposed by some lawmakers, including Sen. Max Baucus (D-Mont.), chairman of the Finance Committee.

The academy also applauded the House bill's approach of not immediately forcing a new payment system upon physicians, but rather providing for study, analysis and collaborative consideration.

"We are further appreciative that the public plan option, like Medicare, preserves physicians' right to voluntarily choose whether participation best serves the dermatologic needs of their patients," the AADA's letter states.

Continued activism

However, Dr. Pariser says, AADA's endorsement does not imply that it will support whatever final plan is approved as the legislation is negotiated in Congress.

"We wrote the letter not because we agree with everything in the bill, but because we wanted to stay in the game. We really have a voice louder than our numbers would suggest, and that's because we're involved," Dr. Pariser says.

Point of contention

The Senate Finance Committee's bill was still being hashed out as lawmakers headed to their districts early in August. However, there was concern that the bill would not resolve the SGR payment issue, leaving it as a major point of contention during House-Senate conference negotiations.

"Doctors cannot plan for their future under this current system," Dr. Pariser says. "They can't be fighting these draconian cuts every year and be expected to invest in technology and other costs of serving increasing numbers of patients."

'Public option'

AADA also is concerned about proposals that would use the Medicare fee schedule as a basis for physician payments in a "public option."

"They are talking about Medicare plus a little, maybe 5 percent," Dr. Pariser says, noting that there is also discussion about whether the fee-for-service system should be retained or some other option considered, such as global payments for treatment of specific conditions.

"If there is a public plan and an alternative physician payment system, we want to be sure it is piloted ahead of time and not imposed on everybody without being tested," he says.

MedPAC

Also of concern to the academy is a proposal giving the Medicare Payment Advisory Commission (MedPAC) power to impose Medicare payments rather than simply make recommendations, as is now the case.

"MedPAC on steroids. Setting payments on their own, without oversight, is worrisome," Dr. Pariser says. "We do not think that's a good idea."

Bob Gatty, former congressional aide, covers Washington for businesses specializing in healthcare and related issues. Contact him at bob@gattyedits.com
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