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  • How we pay for medical care in 2014: Paying for quality and efficiency



    Whitney McFadden
    AMSA Health Policy Chair


    Bodenheimer and Grumbach outlined in their book, Understanding Health Policy: A Clinical Approach, a view of health policy and the faults of our current healthcare system. It seems we are very familiar with the pitfalls of our current system. In order to be clear and not dwell too much on the obvious, our system struggles with overuse and underinsurance/lack of insurance that is being addressed with the Affordable Care Act. Today we pay for healthcare out-of-pocket, with individual private insurance, employment based private insurance, or government financing. Insurance plans for healthcare began in the depression due to unstable payments. Medicare was established to cover the elderly and lower income individuals. Currently physicians are paid in a multi-tier system including fee-for-service, episode illness grouping, capitation (per head fee to general practitioner and specialist), and salary.
     
    2014 will be a year of new payment methods for healthcare. The sustainable growth rate (SGR) has historically be underfunded requiring congressional intervention to avoid the reduction in payment to medical reimbursement that would make it unsustainable. This year, a bipartisan fix will change payments to value based on measure of better quality and efficiency instead of the ...

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  • Health Policy Update: Medicare Patient Access

    By Katie Ni
    AMSA Education & Outreach Coordinator, Health Policy Committee

    <>In a near-impossible feat of bipartisan collaboration in Congress, the House Energy and Commerce Committee has voted unanimously, 51-0, for a bill that aims to solve the long-overdue problem of Medicare’s sustainable growth rate.

    Since 1997, the sustainable growth rate (SGR) has been employed as a method to control Medicare spending by ensuring that increases in expenses for Medicare recipients do not exceed the yearly increase in GDP. However, the SGR formula achieves this goal by cutting payment for physician services. By this method, physicians have faced proposals for significant cuts every year for the past dozen years, followed by last-minute “doc fixes” from Congress that help undo the cuts. SGR has therefore long been a huge headache to physicians, and serve as a disincentive for physicians to treat Medicare beneficiaries. Continuation of the current SGR system threatens to reduce Medicare recipients’ access to health care services every year, and is also costly for Congress to continuously patch up with “doc fixes”.

    The proposed bill, to be called the “Medicare Patient Access and Quality Improvement Act
    of 2013”, will repeal the current SGR system and eventually replace it with ...

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  • Don't Let the Supercommittee Cut Residency Positions!

    As you have probably heard, the Congressional "Supercommittee," or the Joint Select Committee on Deficit Reduction, is scheduled to announce its recommendations to cut $1.5 trillion in federal spending over the next ten years on Wednesday, Nov. 23. The Supercommittee was created by the Budget Control Act of 2011 back in August to avert the debt ceiling crisis. Congress is scheduled to vote on these recommendations by Dec. 23. If Congress fails to adopt Supercommittee recommendations, there will be an automatic sequestration, or across-the-board cuts.

    The Supercommittee is rumored to be contemplating substantial (up to 60%) cuts to Medicare Graduate Medical Education (GME) funding which supports vast majority of residency programs in the U.S. As a result, it is critical that we, as physicians-in-training, make our voices heard on this issue. Please take a few seconds to email your members of Congress and urge them to protect Medicare GME:

    The American Medical Student Association strongly supports continued Medicare GME funding and condemns any effort to cut this funding. Massive cuts to Medicare GME will compromise patient access to care and, in some cases, may result in the closure of some residency programs. As the United States seeks ...

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  • Preserving Funding to Medicaid and Medicare

    By Colin McCluney
    AMSA Education & Advocacy Fellow

    Last week, I had the pleasure of representing AMSA, along with other national leaders, at meetings at the White House and the Capitol to emphasize the importance of preserving funding to Medicaid and Medicare. While key entitlement programs are on the chopping block, we want the voice of physicians-in-training to be heard. AMSA joined with 14 other physician organizations in signing a coalition letter to oppose cuts to Medicaid and Medicare; this letter was hand-delivered to leadership from both parties in the House and the Senate. In addition to expressing our opposition to any reduction in benefits or coverage from Medicaid and Medicare, we emphasized our support for innovation in health care administration to reduce costs.

    Medicare has long been one of the most popular governmental programs, covering over 45,000,000 individuals, and has thus been largely protected from significant cuts. Medicaid, on the other hand, is less well-regarded and is frequently targeted as an opportunity for cuts. Why is this? Perhaps it’s due in part to the unglamorous perception that Medicaid is for poor people, a segment of the population that is hard to mobilize politically, frequently forgotten about and easy to ...

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  • Comparative Effectiveness Research and Cost-Effectiveness Analysis... What's the Difference?

    by Ken Williams
    Graduate Special Student
    The Johns Hopkins University Bloomberg School of Public Health

    Lately, I have had a lot of people ask me about the difference (if there is one) between comparative effectiveness research (CER) and cost-effectiveness analysis (CEA), so I thought that I would take this opportunity to provide a very brief introduction to the subject.

    The American Recovery and Reinvestment Act (ARRA) created the Federal Coordinating Council for Comparative Effectiveness Research (Federal Council), which is charged with coordinating the research and guiding the allocation of the money invested in CER by ARRA. In all, $1.1 billion USD has been earmarked for CER with $300 million going to the Department of Health and Human Service’s (HHS) Agency for Healthcare Research and Quality, $400 million for the National Institutes of Health, and $400 million for the Secretary of HHS. With this amount of money on the line, CER has become a very hot topic here inside the beltway.

    While there are many definitions of CER out there, the Federal Council, in a report to the President and Congress, provides the following, which serves as an overall guiding definition for the entire federal government:

    Comparative effectiveness research is ...

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