Repeal the Sustainable Growth Rate

Legislation on health system reform has been voted on in the U.S. House of Representatives. But the bill that Congress approved on Saturday was missing one critical element: the Medicare physician payment issue.

Swift passage of H.R. 3961, the "Medicare Physician Payment Reform Act," would replace the physician payment system that is widely acknowledged to be dysfunctional and that continually threatens access to care for our nation's elderly and disabled patients, as well as for our military families covered by TRICARE. It also would help provide physician practices with financial stability and predictability and enable them to invest in the infrastructure needed to build a health care system for the 21st century. Without Medicare physician payment reform, the goals of health system reform will remain out of reach.

Please call Rep. John A. Yarmuth and urge a YES vote on H.R. 3961. Use our hotline at (800) 833-6354. You can also send your representative an email.

This legislation would stop the imminent 21 percent Medicare physician payment cut scheduled to go into effect in less than two months. It also would provide a permanent solution to the problem so that Congress will no longer need to apply annual, fiscally irresponsible Band-Aid fixes to stop impending cuts that get worse year after year.

Medicine can no longer support the sort of short-term patches that have been used in the past to postpone true payment reform. This bill could come up as soon as next week, so please tell your representative continue to pursue health system reform and support H.R. 3961.

House passes health system reform legislation

Late this evening, the U.S. House of Representatives passed H.R. 3962, the "Affordable Health Care for America Act," by a vote of 220-215. According to the Congressional Budget Office (CBO), the legislation would raise the percentage of legal, non-elderly American residents with insurance coverage from the current 83 percent to 96 percent. It also includes insurance market reforms that would eliminate exclusions for pre-existing conditions and lifetime limits on total health care spending, and it would provide subsidies for low-income Americans to help them purchase coverage in a health insurance exchange.

The legislation was supported by the AMA and a number of other national physician organizations, including the American Academy of Dermatology, American Academy of Family Physicians, American Academy of Ophthalmology, American Academy of Pediatrics, American College of Physicians, American College of Surgeons, American Osteopathic Association, American Psychiatric Association, American Society of Anesthesiologists, American Society of Cataract and Refractive Surgeons, American Thoracic Society, National Medical Association and Medical Group Management Association. AARP also supported the bill.

The focus now moves to the Senate, where a draft proposal has been submitted to the CBO for review prior to scheduling consideration on the floor.


House approves rule for considering SGR repeal bill

Earlier in the day, the House approved a rule for considering both the health system reform bill and H.R. 3961, the "Medicare Physician Payment Reform Act of 2009." The vote was 242-192, with all but 15 Democrats voting in support and all Republicans voting against. While the rule set parameters for debate on both bills, the imminent congressional recess for the Veterans Day holiday prevented a floor vote on H.R. 3961. That legislation would repeal the sustainable growth rate (SGR) physician payment formula and replace it with a new payment update system with two more generous spending targets. The House is expected to take up H.R. 3961 during the week of Nov. 16.

'Doc fix' collapses, Reid tells colleagues AMA led him astray - TheHill.com

'Doc fix' collapses, Reid tells colleagues AMA led him astray - TheHill.com

Doctor on-Call? Cell-Phone Cameras Can Diagnose Disease

Doctor on-Call? Cell-Phone Cameras Can Diagnose Disease

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S. 1776 Update

U.S. Majority Leader Senator Harry Reid (D-NV) and U.S. Minority Leader Senator Mitch McConnell (R-KY) have reached an agreement that will allow the Senate to proceed to S. 1776 next week.

As such, the cloture vote on the motion to proceed to the bill that had been scheduled for Monday, October 19th is no longer necessary and has been cancelled.

Senators Reid and McConnell will negotiate an agreement which will permit a very limited number of amendments to S. 1776 to be offered and voted upon. We expect that there will be one or more votes on S. 1776 next week, including a critical vote on a motion to waive the budget act with respect to the bill.

While the vote is no longer on Monday, the legislation will still move very quickly. It is critical that you continue to reach out to to your senators and ask them to support of this legislation. Use our hotline at (800) 833-6354 and call your senators or email them here.

Senate to vote on SGR Monday

On Oct. 13, Sen. Debbie Stabenow (D-Mich.) introduced S. 1776, the "Medicare Physicians Fairness Act of 2009," which the Senate leadership announced yesterday will serve as the Senate legislative vehicle for eliminating Medicare's sustainable growth rate (SGR) formula and laying the foundation for establishing a new Medicare physician payment update system.

S. 1776 will be the subject of a cloture vote on Monday, Oct 19. The Senate needs 60 votes to invoke cloture to allow formal consideration of the bill. A vote on final passage is expected to occur late next week, either on Oct. 22 or 23. Senate Majority Leader Harry Reid (D-Nev.), Senate Finance Committee chairman Max Baucus (D-Mont.), and Sen. Chris Dodd (D-Conn.), along with President Barack Obama, are all strongly supporting passage of S. 1776.

Sen. Stabenow's 18-line bill repeals the SGR formula and eliminates all debt that has been accumulated under the current payment system, setting future physician payment updates at zero. Importantly, the Senate leadership made it very clear yesterday that Congress does not intend to implement a permanent physician payment freeze and call it Medicare payment reform.

Rather, by passing a separate bill that repeals the SGR and eliminates the accumulated spending target debt, budget constraints will be eased, allowing a new physician payment update system to be incorporated into a broader health system reform bill. The details of that future update system have not yet been worked out, although certainly the two spending targets that would be created by the U.S. House of Representatives health system reform legislation, H.R. 3200, could be viewed as a starting point.

The procedural path for passing S. 1776 will be complicated, requiring the support of 60 senators on several procedural motions over the next few days. Furthermore, because the legislation is not offset by other spending cuts or revenue increases it will add to the federal budget deficit, raising its controversy and making supporting votes difficult for some senators.

Repealing the SGR is one policy objective that is a common goal for all physicians. Sen. Stabenow's bill creates the pathway the AMA has been seeking to finally achieve that goal. Grassroots activism will be absolutely critical to the success of this strategy.

The AMA has activated its physician and patient grassroots networks, and will be running television advertisements in key states. A unified and concentrated effort by the entire house of medicine will be essential to the AMA's success.

Visit the AMA's grassroots action center to send an e-mail to your senator. Also, the AMA grassroots hotline at (800) 833-6354 can connect you directly to your senator's office.

Sanofi says children under 10 likely to need two H1N1 vaccine doses.

The CBS Evening News (10/14, story 4, 1:20, Couric) reported that "the first injections of the H1N1 flu vaccine were given to the public today, but for children under ten, one shot will not be enough. The vaccine's maker says they'll need two injections to be fully protected."

The AP (10/15, Marchione) reports that vaccine maker Sanofi Pasteur said that tests of its H1N1 "vaccine suggest that children under 10 are likely to need two shots to be fully protected." According to federal officials, these results are "not surprising, since this age group needs two doses of regular seasonal flu vaccine the very first time they ever are given a flu vaccine for full immunity to develop." Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases confirmed that Sanofi's "results back up what government tests are showing."

Bloomberg News (10/14, Serafino) reported that the clinical trials also "showed the vaccine triggered an immune response" that "was well tolerated," and patients experienced no serious side effects. The "Booster Shots" blog of the Los Angeles Times (10/14, Maugh) also covered the story.

College H1N1 cases said to be increasing slowly. In its "Booster Shots" blog, the Los Angeles Times (10/14, Maugh) reported that the American College Health Association said that "influenza-like illnesses, generally assumed to be pandemic H1N1 influenza, continued their slow growth on college campuses with a two percent increase last week." While "regional outbreaks of swine flu appear to have peaked already in the Southeast, Northeast and Mid-Atlantic regions...the Midwest, Rocky Mountain area and Southwest are experiencing increases." Dr. James C. Turner, president of the organization, said, "Many outbreaks will have waned significantly by the time H1N1 vaccine becomes widely available," so the next few months are "a critical period for achieving high rates of immunization among college students before the next wave starts this winter."

Schools, hospitals throughout US deal with H1N1 virus. The AP (10/14) reported, "The largest hospitals in central Indiana are putting more restrictions on visitors as they try to stem the spread of swine flu." Marion County Health Department director Virginia Caine said that "every major hospital in the city has agreed to tougher visitation rules." Methodist Hospital, Indiana University Hospital, and Riley Hospital for Children in Indianapolis will only allow parents, spouses, domestic partners, and clergy to visit patients.

The Washington Post (10/15, Goodman) reports, "Schools and hospitals in Southern Maryland have reported several cases of swine flu, and health and school officials are continuing to battle the virus." The Post adds, "Southern Maryland's three county health departments and school systems are planning to host flu clinics for residents and students." William Leebel, a spokesman for the Charles County Health Department, said that people with "flulike symptoms probably have the H1N1 strain," as "the seasonal influenza usually hits during the winter holidays and in January."