February 12, 2010 - Advocacy Corner

Possible Legislative Fix for ‘Eligible Professional’ Prohibition. An amendment to the jobs bill being considered by the Senate would have allowed certain hospital-based physicians serving Medicare and Medicaid patients to qualify for EHR payment incentives. Majority Leader Reid (D-NV) this week, however, pulled the jobs proposal with the intent of creating two bills. Job-related incentives are scheduled for a vote February 22 and remaining provisions including health-related proposals are slated for later consideration. The larger bill had come under criticism from some Democrats who felt it included too many special interest provisions.

As interpreted by the CMS Proposed Rule published in January, a hospital-based physician, referred to as an ‘eligible professional,’ such as a pathologist, anesthesiologist or emergency physician, who furnishes substantially all of such services in a hospital setting" is not eligible for subsidies under the HITECH act if they furnish "substantially all of such services in a hospital setting (whether inpatient or outpatient) and through the use of the facilities and equipment, including qualified electronic health records, of the hospital.” Eliminating the word “outpatient” in the amended language would seem to deal with the prohibition against hospital-based outpatient physicians qualifying for federal payment incentives.

Other health provisions likely scheduled for a later vote, in addition to amending definition of “eligible professional,” are delay until September 30 of a 21 percent Medicare payment cut for physicians and extension of premium assistance for COBRA through May 31.

Options for Health Reform. No longer front and center, health reform nevertheless remains a major priority for Democrats and some Republicans. House Speaker Nancy Pelosi (D-CA-8) recently suggested that Democrats may use the budget reconciliation process to pass health reform legislation. This maneuver permits Senate passage with 51, rather than 60 votes. Politically, legislation aimed at transforming one-sixth of the US economy exclusively on a partisan basis has major drawbacks, particularly during an election year.

To reinvigorate his health reform agenda, President Obama recently invited both Republicans and Democrats to a health reform summit. While most Republicans reacted negatively to the invitation, Senate Budget Committee ranking member Judd Gregg (R-NH) welcomed the idea in a letter to the President earlier this week, taking the occasion to offer his own proposal. Gregg, who has declined to run for re-election, may see the opportunity to leave his mark as a leader on health reform.

Called, "CPR: Coverage, Prevention, Reform," the legislation is aimed at promoting prevention and providing catastrophic coverage for all families. Provisions include insurance reforms similar to that included in the Democrat’s plan, requirement for individual coverage, targeted subsidies for purchase of insurance, capping the exclusion for employer-sponsored health insurance and a tax deduction for health insurance purchased in the individual market.

On the Medicare side, CPR encourages confidential and public reporting of healthcare acquired conditions and payment incentives to encourage reduction of these occurrences. The proposal would also require the analysis of health care data for quality and efficiency with the results disseminated to payers, beneficiaries and the public. Ultimately, this information would be used to tier Medicare copayments and deductibles to encourage beneficiaries to utilize higher quality more efficient providers. Senator Gregg as yet has not formally introduced CPR. While modest in scope compared to the Democrat’s bill, his proposal could open the door to a possible bi-partisan pathway for health reform.

Grant Awards of $1 Billion Support Health IT. In a joint statement February 12, HHS Secretary Kathleen Sebelius and Labor Secretary Hilda Solis announced awards to advance the adoption and meaningful use of health information technology and train workers for the healthcare jobs of the future. These awards will help make health IT available to over 100,000 hospitals and primary care physicians by 2014 and train thousands of people for careers in health care and information technology.

At state and regional levels, $386 million will go to 40 states and qualified State Designated Entities (SDEs) to facilitate health information exchange (HIE), while $375 million will go to an initial 32 non-profit organizations to support the development of regional extension centers (RECs) that will aid health professionals as they work to implement and use health information technology - with additional HIE and REC awards to be announced in the near future. RECs are expected to provide outreach and support services to at least 100,000 primary care providers and hospitals within two years.

The more than $225 million in DOL grant awards will be used to train 15,000 people in job skills needed to access careers in health care, IT and other high growth fields. Through existing partnerships with local employers, recipients of these grants have already identified roughly 10,000 job openings for skilled workers that likely will become available in the next two years in areas like nursing, pharmacy technology and information technology. The grants will fund 55 separate training programs in 30 states to help train people to meet the growing employment demand for health workers. The HHS and DOL awards are part of an overall $100 billion investment in science, innovation and technology the Administration is making through the Recovery Act to spur domestic job creation in growing industries and lay a long-term foundation for economic growth.