Posted on September 18, 2009 by Michael Cassidy
- Replacing the scheduled 21.5 percent reduction in 2010 Medicare physician payments with a 0.5 percent increase;
- Requiring that all eligible health professionals participate in Medicare’s Physician Quality Reporting Initiative by 2011;
- Creating a 10 percent bonus payment for primary-care and general-surgery providers who practice in health professional shortage areas. Funding for this five-year bonus, to start in 2011, is offset by reducing payments for all other services;
- Establishing the CMS Innovation Center, which would be required to test and evaluate patient-centered delivery and payment models, including payment incentives for physicians if they are deemed to appropriately order high-cost imaging services. The center would be exempt from budget-neutrality requirements for an initial testing period and would be required to consult outside experts and stakeholders;
- Increasing the imaging utilization rate assumption for advanced imaging equipment from 50 percent to 65 percent for 2010 through 2013, which will result in lower practice-expense payments for the technical component of services using this equipment;
- Creating a nonelected Medicare Commission to develop and submit proposals to Congress that extend Medicare solvency;
- Simplifying healthcare administration by "accelerating the development, adoption and implementation of standard, consensus-based operating rules for four HIPAA* transactions: eligibility verification, claims status, payment/electronic funds transfer and remittance advice";
- Expanding the Medicare physician feedback program in 2012 and, beginning in 2015, reduce payment by 5 percent if an aggregation of a physician’s resource use is at or above the 90th percentile of national utilization;
- Allowing groups of providers, beginning 2012, to form accountable care organizations, improve quality of care and share in half of the savings achieved over a three-year period;
- Requiring all individuals to obtain health insurance by 2013;
- Requiring all employers with more than 50 full-time employees to pay a fee if they don’t offer health insurance, beginning in 2013;
- Creating, no later than 2012 and expiring at the end of 2015, the Consumer Operated and Oriented Plan (CO-OP), comprising "nonprofit, member-run health insurance companies";
- Establishing state-based health insurance exchanges beginning in 2010; and
- Providing assistance to Medicare Part D beneficiaries when they reach the "doughnut hole" in benefit coverage
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