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    Health care reform 'Call to Action': Mixed bag for urologists

    Reforms favor primary care; imaging, SGR policies would change

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    Bob Gatty
    Washington—The outline of health care reform under the Obama presidency is beginning to take shape. While there will be positive developments for urologists, there are also areas of potential concern.

    A white paper, "Call to Action: Health Reform 2009," published in mid-November 2008 by Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, includes many of the core principles espoused by President-elect Obama during his campaign. It followed release by the Centers for Medicare & Medicaid Services of its final fee schedule rule for 2009, which provides for an average 1.1% update for physicians.

    Among its many provisions, the CMS document slightly modified rules affecting in-office pathology labs. In it, CMS allows some medical groups to use the services of a pathology lab if it is located within the same building as their primary office without being subject to anti-markup payment limitations.

    Physicians must meet stringent tests imposed by CMS to qualify for the exemption (also see, "CMS relaxes anti-markup restrictions on ancillaries").

    Meanwhile, Baucus' health care reform "call to action" would:

    • establish a policy that ensures meaningful coverage and care for all
    • insist that any expansion be coupled with an emphasis on higher quality, greater value, and, over time, less costly care
    • weed out waste, eliminate overpayments, and design a sustainable financing system that works for taxpayers, recipients, and providers.

    The plan would establish a nationwide insurance pool, the Health Insurance Exchange, through which uninsured Americans could compare and purchase plans of their choice. Private insurers offering coverage through the Exchange would be precluded from discriminating against health coverage applicants on the basis of pre-existing conditions, and premium subsidies would be available for qualifying families and small businesses.

    While the Exchange is being created, the plan would make health care coverage available immediately to Americans between the ages of 55 and 64 through a Medicare buy-in and would phase out the current 2-year waiting period for Medicare coverage for disabled individuals. Every American who is living below the poverty level would have access to Medicaid.

    Baucus' plan would focus on prevention and wellness, rather than illness and treatment. Those who are uninsured would be given a "RightChoices" card that guarantees access to recommended preventive care, including gender-appropriate cancer screenings.

    The Baucus proposal calls for eliminating excess spending in the Medicare program and asserts that imbalances in the current health care system must be excised to offset the high costs of reform.

    One of those imbalances, according to Baucus, is the need to strengthen the roles of primary care and chronic care management, which would be done at the expense of health care specialists, a statement that immediately drew criticism from the Alliance of Specialty Medicine, a coalition representing 200,000 physicians in 12 specialty societies, including AUA.

    Baucus contends that payments for primary care physician visits "are undervalued, particularly compared to procedures and services furnished by specialists." Further, the "overvaluation of procedures in the Medicare physician fee schedule has created financial incentives to provide unnecessary services and served as a disincentive for physicians to become primary care physicians."

    "To avoid cost inflation, this proposal should be made budget-neutral," Baucus said, adding that any increase to primary care providers "requires a corresponding cut to specialty services."

    The document acknowledges that such an approach "has the potential to create significant controversy" among physicians and that reforms should be crafted "in collaboration with the entire physician community and other practitioners."

    That may be difficult.

    Responding to the Baucus proposal, the Alliance for Specialty Care issued a statement.

    "Trying to improve Americans' access to primary care by simultaneously restricting their access to specialty care is not health care reform, and is not in the best interest of patients," the statement declared.

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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