SZD Health Law Scan : Health Care Lawyers & Attorneys : Schottenstein Zox & Dunn Law Firm : Strategic Planning, Managed Care, Insurance : Columbus, Cleveland, Cincinnati, Central Ohio

On October 27, SZD held its Symposium on Health Care Policy Reform in Columbus, Ohio. Guest speakers from across the health care industry confronted today’s toughest reform questions and concerns, including those issues specific to employers, payors, providers and consumers. During the event, we asked panel members to weigh in on those aspects of reform that are the most critical to their particular workplace.

SZD: What elements of health care reform are most important to your company/organization?

Dennis Hicks
Director of Compensation and Benefits
Chiquita Brands International Inc.

A: A big benefit to our company will be the shift to electronic health records and exchange of information. Because we employ so many people in different parts of the globe, there is a tremendous amount of staffing involved in simply having people filling out health insurance forms.

Another important aspect is wellness. The government can play a big role in promoting wellness by paying for vaccines, preventive and more pediatric treatments. Government should also be more involved in financial support of medical education. Doctors need to make so much in order to pay off expensive school loans and get out of debt.

I’d also like to see costs reduced. Historically, government involvement typically doesn’t lead to lower costs and greater efficiency. Take Medicare for instance. For 40 years the government has been talking about Medicare’s waste, fraud and abuse. They’ve had 40 years and they haven’t been able to fix it yet. And I see nothing in the bill right now that breaks the cost curve.

John Popa
President & CEO
Marlite Inc.

A: I’d like to see incentives for doctors that will encourage quality of care, not just for how many procedures or tests are done, as is the case now. One idea would be to have physicians become salaried employees of hospitals with strict quality controls in place enabling patients to get only the care they need and not unnecessary tests and other procedures. What I want for my employees is that they be allowed to go to the provider who can give them the best care, not someone they are seeing under a mandate.

Whatever ultimately happens with health care reform, it should not place an unfair burden on businesses. We feel we have an obligation to provide insurance to our employees. As an American I also feel strongly that I want to do my share to help the uninsured. But I have an issue with other employers who do not feel the same obligation.

I also doubt that increased government involvement will help solve the problems we have in health care; it may just lead to more inefficiency which leads to greater costs. It seems that only 20 percent of the system needs work and the government is trying to get involved in 100 percent.

Steven Gabbe
Senior Vice President for Health Services & CEO
Ohio State University Medical Center

A: Physician reimbursement is a huge issue. Doctors are needed throughout the country in primary care, and unless they are reimbursed enough to repay their school loans, fewer of them will go into primary care medicine. If you cut back on Medicaid and Medicare reimbursements, doctors may be forced to drop those patients and they will be left with fewer choices for care.

For OSU, the residency positions at the medical center are funded through Medicare, and every year we’re faced with uncertainty over whether the residency program will continue to be funded. Doctors should be paid for what they do and paid well. We need to move toward a reimbursement system based on outcomes, but we must define those outcomes clearly or you will have doctors denying service to potentially very sick people who by the very nature of their illness may not have ideal outcomes.

Electronic medical records will certainly go a long way to increase efficiency, reduce waste and improve patient care. At OSU patients can access their records; they can see outcomes of tests and see all the medications they are taking. The response from patients has been very positive. 

Erin Hoeflinger
President
Anthem Blue Cross and Blue Shield in Ohio

A: The ultimate goal of health care reform must be to build a sustainable health care system. At Anthem Blue Cross and Blue Shield, we provide health insurance to 3.3 million Ohioans. Along with our members, providers, customers and employees, we have a significant stake in the outcome of this process. It’s not enough to just implement insurance reform; we have to get it right. And getting health care reform right means addressing the underlying problems of quality and cost so that more people can be covered.

Perhaps the most central issue in the health care debate is access to coverage. Establishing an effective, enforceable mandate to have everyone covered is one significant way to reform the system. Anthem supports health care reform – but without threatening those who already have quality medical benefits through the employer-based, private sector model that right now covers 170 million Americans – 7 million in Ohio.

George Stadtlander
Executive Vice President & Chief Managed Care officer
Medical Mutual of Ohio

A: All citizens should have access to a core set of health care benefits, in other words, guaranteed access. Everyone should participate according to their means in the healthcare benefits system. This eliminates the need for pre-existing condition exclusions.

The cost of the core set of health care benefits needs to be controlled such that the annual increase of such benefits equals the overall inflation rate. Quality improvements in the health care delivery system will result in greater value and in time reduced total cost. Administrative simplification and efficiency will lower overall costs.

The role of the government should be as the regulator, not the regulated. The regulators can not regulate themselves. 

Martin Hauser
President
SummaCare Inc.

A: Although there is still a fair amount of uncertainty about the final design of health care reform, it appears as if several key elements are emerging. Of the components that we are assuming will make it into the final reform bill, we support things such as the desire to ensure that all Americans have access to health insurance coverage and the elimination of pre-existing conditions.

However, these changes cannot occur without a corresponding commitment that there will be some type of requirement that employers offer and individuals acquire health insurance. In addition, we have significant concerns about the lack of details surrounding the proposed Public Option and whether it can be funded and administered in a way that creates an equitable, level playing field.

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On November 19, 2009, the House of Representatives passed the Medicare Physician Payment Reform Act of 2009 ("H.R. 3961"). The bill reforms the Medicare physician payment formula, called the Sustainable Growth Rate ("SGR"). Under the current formula, Medicare payment rates for physicians' services will be cut by about 21 percent in 2010 and additional cuts would occur annually.

The Congressional Budget Office ("CBO") summarized H.R. 3961's changes to the SGR as follows:

• The update for 2010 would be the percentage increase in the Medicare economic index (MEI), which is 1.2 percent, as specified in the final rule.
• Beginning in 2011, there would be separate target growth rates and conversion factor updates for two categories of service: evaluation, management, and preventive services, and all other services.
• The new SGR formula would take into account spending for each category of service since 2009 or—beginning in 2014—for the past five years. (The current SGR formula takes into account spending since 1996.)
• Finally, only physician services, and not other services provided incident to the physician visit (such as laboratory services), would be counted in each category.

As noted above, consistent with the Centers for Medicare and Medicaid final rule for the 2010 physician fee schedule (publication date: November 25, 2009), H.R. 3961 amends 42 U.S.C. 1395w–4(d)(4)(A) to eliminate the discretion of the Secretary of the Department of Health and Human Services to include physician-administered drugs within the definition of "physicians' services" for the purposes of SGR calculations. Physicians' services are currently defined to include:

"other items and services (such as clinical diagnostic laboratory tests and radiology services), specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to a Medicare+Choice plan enrollee." (emphasis added)

Under the proposed definition, such services would be defined to include only:

"other items and services for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than such services when furnished in the facility of a provider of services), but does not include services furnished to a Medicare+Choice plan enrollee." (emphasis added)

The CBO estimated that H.R. 3961 would increase physician payments over the next 10 years by about $195 billion.

H.R. 3961 was received in the Senate on November 20, 2009.

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On November 18, 2009, the Senate released a draft health insurance reform bill, entitled the "Patient Protection and Affordable Care Act."  Like the House bill, the Senate's bill proposes to establish Exchanges, or marketplaces for individuals to shop for insurance when insurance is not available through their employers. The bill contains a public option (referred to in the Senate's bill as the "community health insurance option") but differs from the House bill in that it permits states to "opt out" or prohibit that state's Exchange from offering a community health insurance option.  This bill will expand Medicaid coverage for those people earning less than 133% of the federal poverty line and will provide subsidies for the purchase of health insurance for people earning less than 400% of the FPL.

The Senate's bill stops short of the House's proposed ban on public health insurance options providing coverage of abortion services but it does prohibit the use of federal funds for abortion services.

To pay for some of the costs of the bill, the bill proposes an excise tax on high cost employer-sponsored health coverage (i.e., plans worth $8,500 for individuals and $23,000 for families).  The bill also proposes a tax on elective cosmetic surgeries and an increased hospital insurance tax on high-income taxpayers that would increase the Medicare deduction from 1.45% to 1.95% for incomes over $200,000 for individuals and $250,000 for couples.

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From running real-time texting polls, to coordinating a live video feed from Washington, the Symposium on Health Care Policy Reform made an impression on the 400 people in attendance.

The results are in from the texting polls during the Symposium on Health Care Policy Reform. Surprisingly, the media has influenced over 30 percent of attendees view’s of health reform, while only 18 percent are very optimistic on the likelihood of health care reform legislation to be enacted.

In addition, we have also made the symposium’s presentations available. Participants have been emailed the password to download files. In the coming weeks, we will also release podcasts of each presentation and panel discussion. Check back frequently or sign up via RSS feed for updates.

Click on slides or audio next to the presenter’s name to download their power point slides and audio recording of their presentation.

Mary Jo Hudson, slides, audio
Jeff Biehl, slides, audio
Panel discussion – Employer perspective, audio
Panel discussion – Provider perspective, audio
Panel discussion – Payor perspective, audio
Jennifer Chubinski, slides, audio

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