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PUBLIC
CTs, and PET scans. Physicians now must inform patients in writing
at the time of the referral that they may obtain services elsewhere
and provide a list of others who provide such services in the area.
Physicians already are required to seek preauthorization for most
imaging services. They should not also be required to compile and
maintain a list of other imaging providers. If the federal govern-
ment mandates a list, the government should provide it. More paper,
more processes, but where is the health care?
TMA Ask: Revisit the imaging referral provision and remove the
arduous paperwork requirement, so physicians can spend more time
taking care of patients versus pushing paper.
Antidiscrimination Provisions for Health Plans
The PPACA includes a provision stating health plans may not
discriminate against any health care providers — acting within
their state scope-of-practice laws — who want to participate in
the plan.
TMA Ask: Ensure this provision is not misinterpreted to permit
providers who have not been trained as physicians to misrepresent
themselves as possessing the education, knowledge and training of
physicians.
Restrictions on Hospital Ownership
Throughout the health care debate, the Mayo Clinic, Cleveland
Clinics, and Texas‘ Scott & White Hospitals were held up as the
gold standard of how to deliver efficient and high-quality care.
All these institutions have one thing in common — they are
physician-owned and physician-led. In the future, these types of
institutions are banned. A provision in the PPACA (under the
guise of “fraud and abuse”) actually prevents physicians from es-
tablishing hospitals that participate in Medicare. The PPACA
makes future hospital ownership illegal for physicians who go to
medical school, obtain a license to practice medicine, care for
Medicare patients, and then want to refer their Medicare patients
to a hospital in which they may have ownership. If a physician
had already owned a hospital, the PPACA severely limits how that
hospital can expand and operate moving forward.
TMA Ask: Repeal legislation that limits physician ownership of
hospitals. Promote responsible ownership of all health care facilities,
whether owned by a physician, hospital, or other provider.
FINANCING
Accountable Care Organizations: Fairness
The accountable care organization (ACO) is a new concept in the
PPACA. It asks for physicians to invest in a new model of health
care delivery that increases efficiencies and delivers the right care at
the right time. However, the incentives in the program are left to
the whim of federal administrators. A participating ACO can’t chal-
lenge many government decisions about the performance of an
ACO, including:
1. Whether the ACO is eligible to share in any savings it creates,
2. The amount of shared savings to be paid to the ACO,
3. Which patients the government assigns to the ACO,
4. What measurements the government plans to use to determine
the quality of care the ACO provides,
5. The government’s assessment of the quality of care the ACO
provides to patients, and
6. A determination to terminate the ACO from the program.
TMA Ask: ACO rules must be fair and equitable, and must rec-
ognize physician leadership on issues related to patient care, quality
assurance, and clinical integration. Physicians should not be viewed
simply as another source of labor.
Funding for Health Information Technology
The Health Information Technology for Economic and Clinical
Health (HITECH) Act, which was part of the American Recovery
and Reinvestment Act, provided funding and incentives for physi-
cians to adopt electronic health record technology. As a result, many
physician practices have made significant investments in these tech-
nologies. They are working to integrate these systems into their
practices and meet the “meaningful use” criteria established to re-
ceive the financial incentives. However, just as these investments are
being made, Congress is considering bills that would repeal or sig-
nificantly reduce its support for HIT.
TMA Ask: Protect the HITECH Act from repeal. Continue with
the current incentive program to help physicians acquire electronic
health record systems. This will improve health care in America in
so many ways.
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