House Passes 12-Month SGR ‘Doc Fix’ by Voice Vote

On Thursday morning, March 27, the House passed by voice vote a proposal (HR 4302) to delay for 12 months a scheduled 24% cut to Medicare physician reimbursements, The Hill’s “Floor Action” reports. The bill now heads to the Senate (Kasperowicz, “Floor Action,” The Hill, 3/27).

House Speaker John Boehner (R-Ohio) on Wednesday announced that he and Senate Majority Leader Harry Reid (D-Nev.) had agreed on the proposal (Demko, Modern Healthcare, 3/26).

Background

The current three-month “doc fix” expires on April 1. House and Senate lawmakers had been working to develop final legislation that would repeal and replace the sustainable growth rate formula, which sets Medicare physician payment rates. However, disagreements over cost offsets in separate Democratic and Republican-sponsored proposals threatened to prevent a final bill from being passed before Monday.

Two weeks ago, the House approved a GOP-led bill (HR 4015) with an amendment that would delay implementation of the Affordable Care Act’s individual mandate for five years. However, the White House issued a veto threat, and Senate Democrats have said the amendment is a non-starter and will not be brought up for consideration. Meanwhile, Senate Democrats released their own SGR proposal (S 2110), but it is likely to become entangled in a debate over how to offset its 10-year, $180 billion cost (California Healthline, 3/24).

Details of SGR Patch

According to the AP/Washington Times, the compromise measure contains a slew of additional health care provisions and benefits for physicians, hospitals, drug makers and other providers.

For example, the proposal would:
•Grant Medicare physicians a 0.5% fee increase through the end of 2014;
•Provide higher Medicare payments to hospitals in rural areas and for ambulance services in such areas;
•Establish two new mental health grant programs, one of which would receive $60 million over four years to improve outpatient treatment for individuals with serious mental illnesses (Taylor, AP/Washington Times, 3/26);
•Delay the deadline to implement the new ICD-10 diagnostic and procedure code sets by one year, to Oct. 1, 2015 (Conn, Modern Healthcare, 3/26);
•Delay implementation of the new inpatient payment rule for hospitals, known as the two-midnight rule, by six months, to March 2015 (Demko, Modern Healthcare, 3/26); and
•Implement $2 billion in payment reductions over 10 years to skilled nursing providers (Adams, CQ HealthBeat, 3/26).

In addition, the compromise proposal would delay by an additional year — to fiscal year 2017 — the start of scheduled annual Medicaid reductions to hospitals that treat a disproportionate share of low-income patients, the Washington Post’s “Wonkblog” reports. The expiring three-month SGR patch had already delayed the start of the cuts to FY 2016, which would continue through FY 2023 (Millman, “Wonkblog,” Washington Post, 3/26).

According to Modern Healthcare, the Congressional Budget Office has not issued a full cost analysis of the plan, but it is projected to cost at least $20 billion for one year (Demko, Modern Healthcare, 3/26). However, AP/U-T San Diego reports that a preliminary analysis released Wednesday night shows that health spending would increase by $14 billion over the next two years and about $11 billion of the savings from the proposal would not be accrued until 2024 (Taylor, AP/U-T San Diego, 3/27).

While the bill does not outline any cost offsets over a 10-year period, it includes language exempting it from the usual “PAYGO” scorecard, The Hill’s “Floor Action” reports. The measure would reorganize scheduled Medicare sequester cuts for FY 2024 and 2025 so that they all take place in FY 2024 (Kasperowicz, “Floor Action,” The Hill, 3/26).

AMA Criticizes SGR Patch, Urges House To Reject Bill

Meanwhile on Wednesday, the American Medical Association — which has repeatedly called on Congress to approve a long-term, permanent solution to the SGR problem — issued a statement urging House lawmakers to reject the bicameral compromise SGR patch when it comes up for a vote, The Hill’s “Healthwatch” reports.

AMA President Ardis Dee Hoven said a temporary fix that delays payment cuts also “undermine[s] future passage of the permanent repeal framework” and “would perpetuate the program instability that now impede the development and adoption of health care delivery and payment innovation” (Viebeck, “Healthwatch,” The Hill, 3/26).

Washtenaw County Ranks First in Health Factors for Fifth Consecutive Year

YPSILANTI, Mich., March 26, 2014 – Washtenaw County ranks first among Michigan counties in “health factors” according to the 2014 County Health Rankings released today. This is the fifth anniversary of the Rankings, and the fifth consecutive year that Washtenaw County has received the top ranking for health factors.

The County Health Rankings are based on the idea that no single thing makes us healthy or unhealthy – rather it is a variety of factors such as physical activity, access to healthy food, education and family and community support combined.

“We are incredibly fortunate to have a solid foundation for building healthy communities in Washtenaw County. There is tremendous work happening and strong partnerships in place,” says Acting Health Officer Ellen Rabinowitz. “At the same time, we know we’re not there yet,” she continued. “The Rankings and our own local data can help us fully understand what supports or undermines health in our communities and what we can do about it.”

There are two rankings for each county, one for health factors and one for health outcomes. Health factors include our health behaviors, access to clinical care, social and environmental factors and our physical environments. Health outcomes include how long people live (mortality) and to what degree they report feeling healthy (morbidity). Washtenaw ranks sixth among Michigan counties for health outcomes.

Washtenaw’s overall high rankings provide good information about how we are doing locally compared to other counties and states. Within the county, however, there are significant health differences when we look at outcomes according to where people live, how much money they earn, their level of formal education or their race/ethnicity. For example, while infant mortality rates have improved overall, black babies under one year still die at almost twice the rate of white babies in Washtenaw. Similarly, how long you live may depend on where exactly you live within the county: The average age of death in Sylvan, York and Ypsilanti Townships starts at 64 years. In contrast, it is over 76 years in Bridgewater Township, Saline and Ann Arbor.

Washtenaw’s own source of county health data, called the Health Improvement Plan (HIP), illustrates these disparities in health. Taken together, the Rankings and HIP can help us develop innovative approaches to support health – across our local communities and, often, outside the doctor’s office. In September 2013, Washtenaw County Public Health released “Building a Healthier Washtenaw: Community Health Assessment and Community Improvement Plan.” The report uses local HIP data, the Rankings model of understanding health (depicted below) as well as other sources. It tells the story of our health in Washtenaw, identifies resources and describes work with community partners to set priorities for improving health – especially where disparities exist.

Washtenaw County Influenza Surveillance – 3/14/14

Lab-confirmed Cases: It appears the flu season is winding down. Reports of confirmed influenza in Washtenaw County are at low levels. Locally, we peaked during the week ending January 4th. Influenza A/H1N1 has been the dominant strain this season, with a few cases of influenza A/H3 and B reported as well.

Please see the local flu curve:

http://www.ewashtenaw.org/government/departments/public_health/disease_control/flu-graph-14march2014

Hospitalizations and Deaths: Flu-related hospitalizations in Washtenaw residents are down. Influenza A has been detected in all hospitalized patients, with H1N1 the only subtype found. Average length of stay for patients is 5.8 days (range 1 to 43 days). For individuals where vaccine status is known, 44% were appropriately vaccinated. Almost all adults who were hospitalized had at least one underlying high-risk health condition, including an obesity rate of 46% (compared to a 26% obesity rate for Washtenaw County adults overall – HIP Survey 2010).

Hospitalizations and Deaths in Washtenaw Residents with Confirmed Influenza

Total Hospitalizations*
101

Total ICU Admissions
23%

Hospitalizations
Week of 3/2 – 3/8/14
2

Child Deaths*
(0-17 years)
0

Adult Deaths*
(18 years and older)
4

*Starting Sept 29, 2013

Due to the Winter Storm and Icy Roads Tonight’s General Session with Dr. Jeffrey Kutcher Will Be Rescheduled

Washtenaw Medical Beat #3 on Depression Now Available for Viewing

The Washtenaw Medical Beat can be seen on the Community Television Network, Cable Channel 17, or thru the following link:

The program will air on Channel 17 on March 12 at 3 pm; March 13 at 9 pm; March 14 at 4:30 pm; March 15 at 1:30 pm and 7:30 pm and March 16 at 8:00 pm.

​Polio-like Paralysis in California Children Alarms Govt

US Senator Barbara Boxer has called on the Centers for Disease Control and Prevention to investigate a mysterious illness that causes polio-like paralysis in young children. The condition has affected 20 children in California alone in the last 18 months.

Sen. Boxer sent a letter to the Centers for Disease Control and Prevention (CDC) late last week, urging the agency to consider whether the illness is related to a virus or environmental matters, and if there have been similar reports of such paralysis outside of her home state of California.

“These questions must be answered because it is deeply disturbing to read reports of otherwise healthy children experiencing sudden paralysis,” Boxer wrote in the letter to CDC Director Thomas Frieden, according to AP.

The CDC told AP Frieden “will be giving [the letter] careful consideration.”

A study released on Feb. 24 by doctors at the University of California-San Francisco and Stanford University reported on at least five children that have been hit by weakness or paralysis in one or more limbs that mirrored polio effects.

“These five new cases highlight the possibility of an emerging infectious polio-like syndrome in California,” said co-author Emanuelle Waubant, an MD at UCSF.

The symptoms of those afflicted came in rapid fashion, reaching paralysis in a couple of days, the study found. Movement and sensation did not reemerge during the six-month timespan of the study, and spinal evaluations indicated a condition consistent with polio damage.

“They are absolutely not a cluster because they don’t go to the same school or live in the same town,” Waubant said. “These cases have been seen over the past year and a half.”

All of the children had been vaccinated against polio, Waubant said, though two of the children tested positive for enterovirus-68, a virus associated with symptoms akin to polio.

Still, the researchers maintained that the condition is very rare.

“We would like to stress that this syndrome appears to be very, very rare,” said Stanford co-author Keith Van Haren, MD, in a statement. “Any time a parent sees symptoms of paralysis in a child, the child should be seen by a doctor right away.”

The CDC also said that the cases were still quite rare.

“At this time, CDC does not think the situation in California is a cause for public concern,” Jamila H. Jones, a CDC public health educator, said in a statement to AP given before Boxer’s letter was received.

Jones said the CDC is monitoring what is described as acute flaccid paralysis. She added that the number of cases in California falls into a proportional rate considering the overall population.

Congress Gets House Calls, Rx for Medicare reform by March 31

Physicians from dozens of states are meeting face to face this week on Capitol Hill with their members of Congress, calling for immediate action to eliminate the sustainable growth rate (SGR) formula by March 31 and revitalize the Medicare system.

“It’s important to be here so our members of Congress know that we take this issue very seriously,” said Mary Carpenter, MD, a family physician in Winner, S.D. “In order to keep stability in our practices and for rural medicine, we’re watching what they’re doing very closely to make sure [Medicare reform] happens for our patients.”

Despite a common misperception that Congress doesn’t care what constituents think, 95 percent of federal lawmakers said that staying in touch with the people they represent in their home states is their most important priority, according to a recent survey by the Congressional Management Foundation.

The conference’s two days of congressional visits are expected to be especially influential, given that lawmakers have just a few weeks left to pass bipartisan legislation that would repeal the SGR formula and set Medicare on course toward a modern system of care.

“If we’re not here to talk to our members of Congress, then what is the problem?” said Michael Sandler, MD, a diagnostic radiologist in Detroit, Mich. When lawmakers don’t hear from their constituents, then they think everything is fine, Dr. Sandler said. “We have to demonstrate to them that yes, the SGR is a problem.”

Dr. Sandler has been advocating for SGR repeal since the call began more than a decade ago. “We need to shore up their support, thank them for past support and ask them to work with their leadership to get this done.”

The message seems to be getting through. Enno Heuscher, MD, a sports medicine specialist in Cedaredge, Colo., said there was a notable difference in support for repeal this year over previous years. “We received very positive feedback,” Dr. Heuscher said. “I’ve never had that experience in the past.”

On Wednesday, National Day of Action for SGR Repeal, the bill in the House of Representatives gathered 31 new sponsors, bringing the total number of sponsors to 63 – a sign that physicians’ efforts are working.

For physicians who weren’t able to join their colleagues in visits to Capitol Hill, call your members of Congress at (800) 833-6354, and email them via http://www.FixMedicareNow.org.