Comprehensive Health Care Reform

In March of 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act, into law. According to the Congressional Budget Office, the $938 billion bill will reduce the federal deficit by $143 billion over a decade.

The legislation is expected to cover an additional 32 million Americans by 2019, boosting the percentage of non-elderly Americans with insurance to 94 percent from the current rate of 83 percent. The legislation also establishes a broad new framework of government regulation to prevent insurance companies from denying coverage to people who are sick and to require insurers to provide a minimum level of benefits.

The Vermont Medical Society consistently measured the degree to which the state's physicians are "discriminated against" by Medicare reimbursement by determining how far the state is from a midpoint of two geographic adjusters (GPCI) under the RBRVS payment formula: the physician work component and the practice expense component.

If the health reform legislation had not become law, Vermont physicians would have received 95.604 percent of the midpoint. However, since the law is retroactive to Jan. 1, 2010, Vermont Medicare reimbursements will be 97.676 percent of the midpoint of the two geographic adjusters.

Therefore, as a direct result of VMS' work with other state societies to achieve geographic equality, Vermont physicians will receive an additional 2.07 percent in Medicare payments. In 2007, Medicare payments to Vermont physicians were approximately $110 million, so this change will result in an additional $2.2 million in revenue for the state's doctors.

Sustainable Growth Rate (SGR) Repeal

Due to the SGR, the 2006 Medicare Trustees report forecasts cumulative cuts in the Medicare physician payment update of 37 percent by 2015. VMS worked with other physician groups to repeal the forecasted 4.6 percent cut in Medicare physician payments in 2007. In regards to a long-term strategy, VMS staff is providing direct input on the AMA's strategy to repeal the SGR formula, based on past policy experience in drafting for Senator Jeffords the first legislation to address the SGR formula (S.1660, 2001).

Geographic Practice Cost Indices (GPCI) Reform

VMS successfully advocated for the reauthorization of the 1.0 floor in the GPCI work component of RBRVS that expired Dec. 31, 2006. The 1.0 work floor has resulted in a 2.8 percent increase in Medicare reimbursement for Vermont physicians (in 2004, Vermont's work GPCI was 0.973). VMS staff has been asked by Geographic Equity in Medicare Coalition to be one of two individuals representing the coalition nationally in this effort.

Federal Medical Liability Reform

VMS has repeatedly advocated that Vermont's Congressional delegation support the passage of federal medical liability reform, including a $250,000 cap on non-economic damages