The Affordable Care Act (ACA) enacted an array of new provisions designed to encourage the training of primary care doctors, particularly in rural areas and in parts of the country where the resident-to-population ratio is low, and also expands the types of resident activities for which teaching institutions will be eligible for Medicare reimbursement.  This article discusses what every teaching institution needs to know about how the ACA impacts graduate medical education.

On February 24, 2010, the House of Representatives voted overwhelmingly to remove the exemption from federal antitrust laws granted to health insurers by the McCarran-Ferguson Act.  Despite the lopsided vote (406 to 19, with most Republicans joining all Democrats), the measure’s prospects in the Senate were described as “uncertain.”

Our most recent alert addresses the physician payment disclosure provisions of the health care reform bill and reconciliation package passed by the U.S. House of Representatives on March 21, 2010

The effort to enact comprehensive health care reform has been accompanied by calls from Congress and the Obama Administration for elimination of the exemption from federal antitrust laws that health insurers have enjoyed since the passage of the McCarran-Ferguson Act in 1945.  While the fate of comprehensive reform is now in question, repeal of the antitrust exemption may become even more likely, as legislators scramble to pass at least some of the more popular elements of the legislation.  However, repeal may have a less significant impact on the health insurance industry than either its advocates or its opponents expect.

Much of the debate concerning the proposed health care reform legislation has centered on the impact to the health insurance industry and the specter of a public option. Given this focus, it is easy to overlook what will be one of the most significant changes to the premarket review process for biologics  by the U.S. Food and Drug Administration (FDA) in some time. The Kennedy – Eshoo Amendment proposes to establish a generic, or “similar,” approval pathway for biologics, similar to the Hatch-Waxman Act.  This article briefly summarizes the amendment, and reviews some of the significant regulatory issues impacting the approval of biosimilars.

Health care reform is sure to have a significant impact on the current system of employer-provided workplace coverage.  Even though we don't yet know what form any final legislation will take, reading the tea leaves, our lastest posting considers what employers should expect.

The “medical home” model of patient care has been the subject of much attention in recent years, as many experts believe it has the potential to simultaneously reduce the cost of health care and improve the overall health and well-being of patients.
The foundation of the medical home model is the primary care physician, who is responsible for coordinating all aspects of an integrated treatment plan for patients with chronic conditions, from ordering laboratory tests to seeking consults from subspecialists. Proponents of the medical home model believe that centralization of care will substantially reduce the ordinary expenses incurred under the fragmented patient care system that currently exists in America. Under the existing American patient care model, patients typically visit several different physicians, hospitals, and specialists throughout their lives, often resulting in expensive and unnecessary duplicative tests, and even more seriously, in contraindicated medications and treatments. The theory behind the medical home model is that by providing a central base, or “home,” for the coordination of patient care, doctors can improve rapport and relationships with patients as well as prevent unnecessary visits to the emergency room or hospital. 

On July 16, 2009, the Office of the National Coordinator for Health Information (ONC) Health IP Policy Committee voted on recommendations from workgroups, including a matrix of the qualifications that define “meaningful use” of health information technology (HIT) in order for providers to obtain incentive payments from stimulus funds. The incentive payments will begin in 2011 and be paid through 2016, with penalties commencing in 2017 if providers have not achieved “meaningful use” of an electronic medical record (EMR) by that time.

In order to qualify for the first year incentive payment in 2011, (up to $18,000 per physician), an eligible provider must meet the established 2011 measures that correspond with the HIT Policy Committee Health Outcomes Policy Priority Objectives. One of the policy priorities is to improve care coordination with the goal to “exchange meaningful clinical information among professional health care team.” The defined Objective to meet this goal is the “capability to exchange key clinical information” and the corresponding measure is the ability to show that the provider has the “implemented ability to exchange health information with an external clinical entity” such as labs, care summary, and medication lists. Click here to view the matrix accepted by the HIT Policy Committee.

Improving the quality of health care services delivered and reducing the cost of such services must be among the primary goals of health care reform. At first blush, these goals may seem incompatible, but a proposal currently pending before the United States Senate includes provisions that would reform the health care delivery system through the use of accountable health care organizations (“ACOs”). Accordingly, the purpose of this article is to explain how ACOs could operate and to encourage our health care provider clients to focus on this potential linchpin of the reform of our health care system.

In May 2009, identical legislation was introduced in the Senate and the House of Representatives proposing to increase the number of Medicare-supported residency positions across the United States by 15%, or approximately 15,000 positions. The bill also proposes changes in the distribution of currently available positions and encourages the creation of new positions in primary care and general surgery programs. In preparation for such legislation, all institutions sponsoring graduate medical education programs must have a strategic vision for the size and mix of their current and future residency programs.

Ongoing health care reform discussions in Washington focus on subsidies to help low- and moderate-income Americans buy insurance on new health insurance exchanges, an expansion of Medicaid to cover the poor, incentives to encourage small businesses to offer health insurance to their workers, and an individual mandate that requires everyone to have health insurance, just as we do car insurance. Congressional leaders struggle with ways to pay for health reform without increasing the national deficit. Many of these concepts have a familiar ring to Massachusetts health care consumers and bring back memories of the 2006 health-reform debate for Baystaters. The challenges now facing the Congress closely align with those that confronted the Massachusetts Legislature just before adoption of the Massachusetts health care reform law (Chapter 58 of the Acts of 2006) enacted April 12, 2006.