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Physician's Issues

I have always been interested in policy areas concerning physicians, particularly as husband to a Doctor. Below are some examples of this leadership and a summary of my record on these issues.


Dan's Record

Reimbursement Under Medicare

Medicare has established a wide variety of very specific rules governing payment for covered services under Parts A, B, and C - Part D is not subject to Medicare payment rules because these services are managed by private prescription drug plans.  For example, Medicare pays for most acute inpatient and outpatient hospital services, skilled nursing facility services, and home health care under what is known as a prospective payment system (PPS) established for the particular service.  The PPS is a predetermined rate that is paid for each unit of service such as a hospital discharge or payment classification group.  However, payments for physician services, clinical laboratory services and certain durable medical equipment are made on the basis of fee schedules.  To complicate things even further, certain other services are paid on the basis of reasonable costs or reasonable charges.  Regardless of what payment formula is used, in general, the program is supposed to provide annual updates of the payment amounts to reflect inflation and other factors but things do not always work out that way.

I repeatedly hear from Hoosiers in the health care professionals about the inadequacies of Medicare’s benefits and payment polices and how much they are hurting providers and the patients they care for.  Almost every medical specialty that cares for Medicare beneficiaries – physicians, certified registered nurse anesthetists, lab technicians, physical therapists, hospices, home health care, and durable medical equipment providers – seems to be struggling under Medicare’s existing reimbursement rates.  In response, many bills have been introduced in the Congress over the years to reform, update, and even expand existing Medicare benefits and Medicare’s method of reimbursement.  Given the financial crisis Medicare is currently facing, which is projected to get significantly worse in the future as more and more baby-boomers come into the system, expanding Medicare or increasing reimbursement rates is a daunting task.  Over the long-term, it is questionable whether the existing funding mechanisms will even be able to sustain the Medicare program.

Financing Medicare is definitely going to be one of the largest domestic policy challenges facing future Congresses.  The whole system really needs repairing, and to date, all that has been done is to slap a short-term “patch” on the financial bleeding to keep the program limping along.  I want to see Congress step up and comprehensively – not in a piecemeal fashion – reform Medicare’s benefits and payment policies.  Until then, we are stuck with a costly, open-ended entitlement program.  The time has come for Congress to transform Medicare into a 21st century health delivery program that continues to provide beneficiaries with high quality appropriate health care services, while at the same time maximizing cost controls and limiting taxpayers’ exposure to massive tax increases.

The HEALTH Act

Help Efficient Accessible Low Cost Timely Healthcare (HEALTH) Act of 2007, that I sponsored, sets forth provisions regulating lawsuits for health care liability claims concerning the provision of health care goods or services or any medical product affecting interstate commerce.

The bill did the following:

  • Sets a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions.
  • Provides that nothing in this Act limits recovery of the full amount of available economic damages. Limits noneconomic damages to $250,000. Makes each party liable only for the amount of damages directly proportional to such party's percentage of responsibility.
  • Allows the court to restrict the payment of attorney contingency fees. Limits the fees to a decreasing percentage based on the increasing value of the amount awarded.
  • Prescribes qualifications for expert witnesses.
  • Allows the introduction of collateral source benefits and the amount paid to secure such benefits as evidence. Prohibits a provider of such benefits from recovering any amount from an award in a health care lawsuit involving injury or wrongful death.
  • Authorizes the award of punitive damages only where: (1) it is proven by clear and convincing evidence that a person acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury the claimant was substantially certain to suffer; and (2) compensatory damages are awarded. Limits punitive damages to the greater of two times the amount of economic damages or $250,000.
  • Limits the liability of manufacturers, distributors, suppliers, and providers of medical products that comply with Food and Drug Administration (FDA) standards.
  • Provides for periodic payments of future damage awards.

Reducing Fraudulent and Imitation Drugs Act of 2007 

Directed the Secretary of Health and Human Services to require the incorporation of counterfeit-resistant technologies into the packaging of prescription drugs, and for other purposes.

Medicare Physician Payment Reform and Quality Improvement Act of 2006 

The bill would:

  • Make quality improvement assistance available to all health care providers, practitioners, and plans that want help improving care.
  • Reform the Medicare beneficiary complaint process by making it more transparent and accountable to consumers, and allowing QIOs to conduct outreach to beneficiaries and teach providers proven methods for promptly resolving consumer concerns.
  • Increase the breadth of experience and consumer representation in QIO governing bodies.
  • Secure local stakeholder and national expert input on quality and patient safety goals.
  • Increase competition for QIO contracts from three to five years, with a 10 year contract cap.
  • Strengthen evaluations of impact on health care quality for both individual QIOs and the national QIO program.
  • Guarantee a funding floor for the program and ensure the allocation of increased resources for expanded responsibilities.
  • Offer states the opportunity to improve the quality of health care for Medicaid beneficiaries through the QIO program.

 

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