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Sat Jul 18 20:54:48 BST 2009

Here is what I received. I would like to learn about the counter-points to the presentation below.

 We are writing to inform you that the American College of Surgeons is supporting this first step in health care reform legislation entitled "America's Affordable Health Choices Act of 2009" (H.R. 3200), which is currently being considered in the US House of Representatives. This is an ongoing process that will require the College to evaluate our support and level of engagement at each step of the process, and does not lock us into a specific position as the legislation goes through additional changes and is finalized.
This decision was made after careful consideration by the ACS Health Policy and Advocacy Group and extensive discussions with the leadership of all the major surgical organizations. Ultimately, the decision to support the bill was made unanimously by the Executive Committee of the ACS Board of Regents.  Our support helps us to ensure that the final bill includes language that we support and does not include language that we oppose.  We would like to take this opportunity to provide you with an explanation of why the ACS leadership felt that it was important for the College to support H.R. 3200. 

This legislation embodies many of the top legislative priorities of the College. The leaders within the College, including the Regents, the Governors and various committees, have had extensive, ongoing discussions related to health care reform and how these issues impact surgeons and surgical patients.  A major part of this discussion included the health care reform statement that the ACS Board of Regents and Governors developed and approved last year. Surgical workforce issues are a significant part of this statement.  One of the most important priorities related to workforce is the need to address the underlying problems of the Sustainable Growth Rate (SGR), which is used to calculate Medicare physician payments.  This legislation (H.R. 3200) would allocate $284 billion to fix the Medicare physician payment system and eliminate the more than 40 percent cuts in payments to physicians that are scheduled to take place over the next four years, giving surgeons stability for the first time in 10 years. 

The bill would stop the pending 21.5 percent cut in Medicare reimbursement that will occur on January 1, 2010, and replace the cut with an increase based on the Medicare Economic Index.  Second, it would reset the budget baseline for the Medicare payment system to 2009.  Resetting the baseline, in addition to action by the Centers for Medicare and Medicaid Services (CMS) to remove physician-administered drugs from the SGR formula that have negatively impacted Medicare physician payments, will finally provide a long-term solution to the difficulties that have plagued Medicare payment reform for the better part of a decade.  Also, rather than implementing untested models of care and reimbursement, H.R. 3200 would implement pilot programs to test various delivery system reforms that would build on models that have been shown to improve quality of care. Collectively, these measures would stop years of scheduled cuts in Medicare payments, better align incentives to improve quality, and ensure that surgeons will be able to care for patients without the annual concern of Medicare payment cuts. 

What is included in the bill is important. However, what is not included in the legislation is also critical, particularly to surgery. While the bill addresses challenges facing primary care, it does not finance increased payments for primary care through reductions in payments for surgical care.  The College appreciates that the legislation recognizes that such payment cuts would exacerbate the trend of declining payments for many surgical services and would threaten patients' ability to access these important services. 

The legislation does include a public health insurance option.  While the public health insurance option does raise a number of questions, the College insisted that any public health insurance option not mandate that individual physicians participate in the program.  The legislation very clearly allows for physicians to opt-out of the program, with no penalties for doing so.  In order for a public option to be successful for patients and for physicians, physicians need to be able to have the same voluntary participation options that are available to them under any other plan. The College is grateful that this legislation would ensure that physicians will continue to have the freedom to make determinations that are in the best interest of their practice and ultimately their patients. 

Support of H.R. 3200 is advantageous from a strategic standpoint as well. Legislation that will be introduced in the Senate soon is not expected to be as favorable for physicians.  The legislative process will require the House and Senate bills to be reconciled before Congress votes for final passage, and we need to ensure that the College's top priorities, currently included in the House bill, remain intact. 

The ACS leadership and staff remain very engaged in the health care reform efforts in Washington.  Once again, this is an ongoing process that will require the College to evaluate our support and level of engagement at each step of the process.  We will continue to work with both the House and Senate to ensure that any comprehensive health care reform legislation will contain the College's priorities and promote Americans' access to both quality coverage and care.  The College's Washington office will soon host another webinar to provide Fellows with a detailed overview of the current status of health care reform legislation as it makes its way through Congress.  Additional details about this webinar will be sent to Fellows on Monday, July 20, 2009.

Sincerely,

L.D. Britt, MD, MPH, FACS -- Chair of the ACS Board of Regents 
Michael Zinner, MD, FACS -- Chair of the ACS Board of Governors 
Andrew Warshaw, MD, FACS --- Chair of the ACS Health Policy and Advocacy Group 
Thomas Russell, MD, FACS --- ACS Executive Director
--
Kind regards,
Phil
Phil Caropreso, MD, FACS
1813 Grand Avenue
Keokuk, Iowa, USA, 52632
pjcabdds at mchsi.com 
  -------------- Original message from Doc Holiday <drydok at hotmail.com>: --------------

> I am not an ACS member - is it possible to post a copy of this document to the 
> List to show what the problem is?
> 
> 
>  
> 
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ACS HR 3200 Endorsement