Twenty Ways Health System Reform Will Affect Physician Practice

The Pennsylvania Medical Society has identified some of the biggest impacts health system reform will have on physician practice. Below is a synopsis of those issues. Read our full analysis. (Requires Adobe Acrobat Reader)

1. Medical liability grants to states and liability protection for free clinics

2. Limits on physician-owned hospitals' participation with Medicare  
3. Disclosure requirements to refer Medicare patients for in-office ancillary services  
4. Administrative simplification through health plan uniform standards and business rules for the electronic exchange of health information
5. Medicare payment changes such as primary care and general surgery bonuses, continued PQRI incentives, and extending the floor on the geographic adjustment to the work portion of the Medicare fee schedule
6. Increasing Medicaid payment rates for primary care physicians
7. Creation of an independent payment advisory board to propose ways to reduce costs and improve quality of care for Medicare beneficiaries
8. New employer requirements, including penalties for businesses with more than 50 employees that do not offer health insurance and tax credits to small businesses who contribute to employee health insurance
9. Health insurance benefit changes, including excluding over-the-counter drugs from being reimbursed through an HRA or health FSA, increasing the tax on distributions, and limiting contributions
10. An excise tax on taxable medical devices and a tax of 10 percent on indoor tanning services

11. Allowing Medicare accountable care organizations (ACO) to share in cost savings they achieve for the Medicare program beneficiaries

12. National pilot program on payment bundling
13. Comparative effectiveness research through a non-profit Patient-Centered Outcomes Research Institute
14. Waste, fraud, and abuse reduction through provider screening and enhanced oversight periods for new providers and suppliers
15. Medicare and Medicaid coverage of preventive services without patient cost-sharing
16. Workforce training and development initiatives including increasing graduate medical education training positions, increasing scholarships and loans, and providing grants to providers in medically underserved areas
17. Strengthening trauma care through a new trauma center program
18. Requirements that providers, suppliers, Medicaid managed care organizations, and Medicare advantage organizations “report and return” overpayments
19. Reduced Medicare payments for the technical component of imaging for subsequent procedures on consecutive body parts
20. Extension of exceptions for outpatient therapy caps for Medicare services

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Comments: 10


Health system reform is a step toward increasing patient access to care, but PAMED beleives it falls short in some areas and could create more red tape for physicians. http://www.pamedsoc.org/HomePageNews/Health-Reform-Passes.aspx

Dr. Goodyear at 4/11/2010 10:13:07 PM


The Pennsylvania Medical Society neither supported/endorsed, nor opposed the recently passed health care package. The above is simply a detailed analysis of the bill. As I stated, t is difficult for PAMED to speak glowingly or disparagingly of the bill. See my full statement at: http://www.pamedsoc.org/MainMenuCategories/Resources/MediaResources/StatementsTestimonyInterviews/Health-system-reform.aspx

Dr. Goodyear at 4/11/2010 10:10:02 PM


Thank you for taking the time to analyze this information. As a small primary care office administrator and the spouse of a family physician, we are very pleased with passage of the bill although as the elements are applied, amendments will surely need to be made. Firstly, we are looking forward to the 35% tax credit, beginning this year, on the ridiculously high premiums we pay to cover ourselves and our employees. Second, we are tired of struggling to get care for our patients who are uninsured or underinsured. Anything that helps standardize the vile paperwork we all deal with on a daily basis will be great, especially the constant struggles with the drug companies ever-changing formularies. Even if we end up dealing with more managed care, at least it will be standardized. The biggest problem is still a lack of primary care physicians, and they must fix this very quickly. We precept students, and they are telling us that fewer students every year choose primary care. Yes I am a Democrat; Dr Turchi is unaffiliated. No, we are not in favor of a single-payor system. We noted with amusement that the stocks of the health insurance companies rose immediately following passage of the bill. I don't think that sounds like socialism. Best of luck for all.

S Turchi, Administrator at 4/9/2010 1:46:12 PM


item 15. This will encourage more seniors to get yearly physical exams stressing preventive care. A very good thing, as many seniors only come to the office for "sick" visits.

L. Peter Soraruf MD at 4/9/2010 9:32:52 AM


I can't wait to help people as an indebted bureaucrat... I mean doctor.

Medical Student at 4/9/2010 1:07:27 AM


Allowing Medicare accountable care organizations (ACO) to share in cost savings will likely encourage overzealous review and burden on providers. This should not be allowed unless there is a check mechanism that allows for prosecution of these organizations who attempt over burdensome review for profit.

anonymous at 4/8/2010 9:01:03 PM


@Mark and Docmatt : Not to disagree with your remarks, since we don't really know much of what will happen when you try to add 30 million (mostly Medicaid) insured to an overworked force (that often doesn't accept Medicaid) but the EHR mandates from the Stimulus package may be causing more immediate harm, causing small practices to merge or go out of business. Noone even debated that insertion into the Stimulus bill or asked for broad physician input. Hopefully there is still time to remove those mandates and just keep it as an incentive program. Physicians should be allowed to make their own choice how to make their practice more efficient, not have Obama and Pelosi tell us they are doing us a favor ("by having less paperwork") Regarding the current Health Care Reform, CNN's Sanjay Gupta recently said that there would be undercover investigations (Federal Agents pretending to be patients). Although Obama said he would think about it, I don't recall where it got into law? Also, I don't know what is in the new health care to allow physicians to appeal decisions from insurers. Insurance companies continue to be local Monopolies, as Obama wouldn't go along with out-of-state competition to lower premiums or to repeal the anti-trust exemption (which the "House" overwhelmingly passed). The only competition is for the small percent to be on the State Exchanges in 2014. Insurance companies continue to increase punishment for non-participating providers, without regulation. Whereas more dentists are able to survive as non-participating, MDs are not in that position. If they would have had a true compromise of ideas, from the beginning, there would have been a much better bill, that would have reduced premiums without hurting health care.

anonymous at 4/8/2010 6:18:27 PM


What are you going to do when the enormous U.S. deficit comes due and there are no more funds for health care? If you had kept healthcare away from the government, the answer would be simple, wouldn't it? Now, once again, what are you going to do?

Dr. Ryscavage at 4/8/2010 5:57:06 PM


Just a question--did you from the PMS download this directly from the Democratic national committee website or did you even take the time to see if the physicians in PA were in favor of this bill before you apparently blindly endorsed it? I agree with the prior physician that this is indeed a train wreck for PA physicians!

Docmatt at 4/8/2010 5:26:29 PM


In all due respect, what are you guys in PMS smoking? The above is an introductory list of more-of-what-is-to-come penalties heaped upon an already overworked physician population in order to bolster a government-run, doomed train wreck of a 2,000 page patchwork bill that nobody understands nor can interpret yet. Where are you going to find the physician manpower to remain in medical practice under these conditions? Wow. Good luck to all of us.

Mark Polis, MD at 4/8/2010 5:13:35 PM

Last Updated: 4/9/2010
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