Reform is reality

April 15, 2010

As members of the healthcare industry try to unravel the comprehensive health reform legislation that President Obama signed into law March 23, they are voicing concerns about such issues as patient access, payment for physicians, the creation of a new oversight board, and new taxes on medical devices.

Washington, DC-As members of the health-care industry try to unravel the comprehensive health reform legislation that President Obama signed into law March 23, they are voicing concerns about such issues as patient access, payment for physicians, the creation of a new oversight board, and new taxes on medical devices.

Health-care advocates have long sought some sort of system-wide reform, and they say they are glad that the bill increases access to vision care for some patients.

However, because the bill did not address the controversial sustainable growth rate (SGR) formula that has plagued physicians for years by calling for pay cuts once certain Medicare spending targets were reached, some physicians could start restricting the number of Medicare patients they ultimately see, limiting their access to health care.

Some provisions are designed to take place this year, such as banning new physician-owned hospitals in Medicare, and limiting the growth of older physician-owned hospitals. The legislation supports comparative effectiveness research by establishing a non-profit Patient-Centered Outcomes Research Institute, and imposes additional requirements on non-profit hospitals.

Other provisions are slated for 2011 and beyond. For example, Medicare beneficiaries will receive access to a comprehensive health risk assessment and a personalized prevention plan, along with incentives to beneficiaries to complete behavior modification programs. It also will restructure payments to Medicare Advantage plans by setting payments to different percentages of Medicare fee-for-service rates, and prohibit Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare-covered benefits than is required under the traditional fee-for-service program. In 2013, the plan establishes a national Medicare pilot program to develop and evaluate paying a bundled payment for acute, inpatient hospital services, physician services, outpatient hospital services, and post-acute care services for an episode of care.

Ophthalmology Times asked members of the AAO, ASCRS, and a few others to share their thoughts on this sweeping legislation as they try to understand its benefits and drawbacks: