American College of Physicians: Internal Medicine — Doctors for Adults ®


Policy briefs

From the July-August ACP Observer, copyright 2003 by the American College of Physicians.

New House bill based on ACP proposals to expand access to care

On June 10, legislators introduced a bill in the House to expand health insurance coverage to millions of uninsured Americans. The proposal immediately had the support of organizations representing more than 300,000 physicians.

Reps. Steven LaTourette (R-Ohio) and Marcy Kaptur (D-Ohio) introduced the Health Coverage, Affordability, Responsibility and Equity (HealthCARE) Act of 2003 (H.R. 2402). The bill is identical to legislation introduced in the Senate in May. Both proposals are modeled after ACP's seven-year plan to expand access to care to all Americans by 2010.

The bill would give states new options to expand coverage through existing public programs. It would also give individuals a tax credit to buy coverage from private plans.

In a statement, ACP President Munsey S. Wheby, FACP, noted that during 2001 and 2002, 75 million Americans went without health insurance at some time. "We can no longer afford to ignore the problem of the uninsured because it is too complex, too partisan or too risky," he said.

The House legislation would expand access to care through the following measures:

  • Give states new options to expand safety net programs for the poor.

  • Create refundable tax credits to give eligible individuals the same subsidies to buy health insurance that the federal government gives its employees.

  • Allow tax credits to be used to buy individual coverage or coverage through a state purchasing pool modeled after the Federal Employees Health Benefit program.

  • Give small businesses access to the same types of affordable health plans available through state purchasing arrangements.

  • Create an expert commission to recommend additional measures.

Supporters of the legislation include ACP, Families USA, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology and the American College of Geriatrics.

More information is online.


Tighter budget for Medicare carriers could hamper physician pay

A Bush administration proposal to barely increase funding for the nation's Medicare carriers threatens efforts to ensure physicians are paid promptly and correctly.

In a May 19 letter to Sen. Ted Stevens (R-Alaska), chairman of the Senate Appropriations Committee, ACP joined 57 other organizations in protesting the president's proposed budget for Medicare carriers in 2004. The administration has proposed giving Medicare carriers $2.497 billion next year, an increase of only about 1% over the current budget.

The letter pointed out that Medicare carriers need better funding to make sure physicians are paid quickly and correctly for their services. In an era of waning Medicare reimbursements, the groups said, physicians need to be assured that their pay will be processed without problems.

The president has also proposed cutting carriers' funding for physician education and training by 85%. Because regulators expect physicians to comply with thousands of pages of rules, regulations and requirements, the letter said, physicians need help from their carriers and medical directors. The proposed funding cut, the groups argued, jeopardizes physicians' access to those services.

While the groups applauded a recent decision to drop a plan to tax physicians who submit paper claims, they protested a proposal to adopt new user fees totaling $201 million for physicians who submit duplicate or "unprocessable" claims. The groups also took exception to a proposed $50 user fee for physicians who work with a qualified independent contractor.

The letter is online.


Medicare to put coding information on Web for free

After several years of effort, ACP has convinced the Centers for Medicare and Medicaid Services (CMS) to make its correct coding initiative (CCI) "edits" available on the Medicare Web site.

CCI edits are pairs of codes that are not separately payable, except under special circumstances. Medicare uses these edits to decide whether to pay claims in full, pay a partial claim, completely deny claims or recode a submitted procedure. The CCI currently contains more than 100,000 coding edits.

Physicians have been frustrated because they haven't had free access to CCI information on how to code "properly." Currently, physicians must purchase the edits and quarterly updates for an annual subscription of $300 for a print version or $260 for an electronic version.

CMS plans to make the edits available free of charge on the Medicare Web site later this summer. For more information on the correct coding initiative, click here.


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