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NARR: Challenges to federal health reform, in the states. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The Affordable Care Act faced voters in Missouri and a federal judge in Virginia. Those are just two of the 21 states where politicians are challenging the law. Here's Mary Ellen Schneider with more:

SCHNEIDER: Missouri voters registered their displeasure at the ballot box, with 71% approving a law that would bar a requirement to purchase health insurance. While any state measure would be trumped by the federal law, opponents say it proves that health reform is unpopular. Meanwhile, a federal judge ruled that Virginia's Republican attorney general can move ahead with his suit challenging the constitutionality of the health reform law.

NARR: So the challenges in the states will continue...but meanwhile it turns out that the health reform law is helping extend the life of the Medicare program. That's according to two reports--one from the program's trustees and the other from the Medicare agency itself. The trustees said that health reform is keeping Medicare's Hospital fund solvent for an extra 12 years--until 2029. And Medicare officials predict that payment changes could save the program 8 billion dollars by the end of next year. What's driving the savings? In the short-term, it's cuts to Medicare Advantage payments and changes to hospital payments. Eventually, CMS expects to see big savings from accountable care organizations, bundling of payments, and reducing hospital readmissions. Those changes could bode well for office-based physicians, said Robert Doherty of the American College of Physicians.

DOHERTY AX: "If you look at an accountable care organization or a bundling of payments, one way you can finance that that could be beneficial to physicians, is that if you can achieve savings say by reducing preventable hospital admissions of those models, some of those shared savings can go back to the physician. Right now under Medicare, part B is part B and part A is part A and never the twain shall meet."

NARR: But here's a potential problem area, according to Mr. Doherty. It's the Independent Payment Advisory Board. The panel is supposed to recommend payment changes to slow Medicare spending. If Congress doesn't actively reject the recommendations... and find their own savings... the changes would go into effect. Medicare estimates that the Board could save 23 billion dollars by 2019. Some senators see that panel as a way around their authority. Not surprisingly, they want it out of the health reform law. Texas Republican John Cornyn has introduced a bill to do just that-- it's called the Health Care Bureaucrats Elimination Act.

NARR: Well, House members have been called back to Washington this week. They'll be voting on increased Medicaid funding for the states. So stay tuned for more on that and other health reform updates. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Coverage and controversy in women's health. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The new health reform law could have a big impact on health coverage for women. That's according to a new analysis by The Commonwealth Fund. Women are as likely as men to be uninsured, but pregnancy and childbirth make them more vulnerable to higher health care costs. But the Affordable Care Act means as many as 30 million women could be removed from that vulnerable category. Study author Sara Collins explains.

Collins AX: "Most women who are uninsured and underinsured will gain access to comprehensive health insurance beginning in 2014 under the new law. But early provisions, many of which go into effect this year or have already gone into effect, will provide important transitional relief for millions of women."

NARR: The authors also said the law will encourage doctors to stay in primary care and keep seeing Medicare and Medicaid patients.

NARR: Well, it's hard to talk health reform...and women's health... without some controversy. A new preexisting condition coverage plan is going into effect...and Republicans say the Obama administration hasn't ensured that federal dollars won't pay for abortions. The White House says that's just not the case. Abortion is only covered in the case of rape, incest or where a woman's life is endangered, according to the Obama Administration. But don't expect that to be the final word. Congressman Chris Smith, who's a Republican from New Jersey and a staunch abortion opponent, has introduced a bill that would permanently ban federal funding of abortion...and if you're confused and thought that federal funding of abortion is already banned. You're right. That's the Hyde Amendment, and it's still in effect.

NARR: Meanwhile, Congress is moving to spend the money needed to implement health reform. Not surprisingly, partisan politics is playing a role in that too. Alicia Ault has more.

AULT: The Senate Appropriations Committee voted along party lines to approve a massive 170 billion dollar labor, health and education spending bill. That figure included funds to train more primary care physicians and to create new medical home projects. The panel also moved to start paying for the 750 million dollars in spending on disease prevention called for by the Affordable Care Act. It appropriated 688 million dollars for a public health program to prevent and reduce obesity-related disease. The funds still have to be approved by the Senate and the House.

NARR: Well, Congress is now headed into its August recess. Health care is going to remain on the political agenda though. The state of Missouri is voting on a ballot initiative to ban the individual insurance mandate. Other states are planning the same thing...which means the health reform law will be a big issue for the fall campaign. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: What was old is new again. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: If you cast your mind back to last fall, you might remember when the public option died...as part of the health reform debate. Well, now Congressman Pete Stark of California and some of his fellow House Democrats have introduced a bill to bring it back. Here's Mary Ellen Schneider with more:

SCHNEIDER: The bill would create a government-run insurance plan to compete alongside private plans in the health insurance exchanges that are set to launch in 2014. The Congressional Budget Office estimates that adding the public option could save the government 68 Billion dollars from 2014 to 2020. Consumers would save too, the CBO said, with a public plan offering lower premiums than others in the exchange. But the chances for success don't seem too strong. The midterm elections are just a few months away and Democrats are likely to lose seats this year.

NARR: Another hot topic from last year was comparative effectiveness research. Unlike the public option, comparative effectiveness research or C-E-R did make into the health reform law. Senate Finance Committee Chairman Max Baucus is touting the C-E-R institute that's created under the law. While the criticism on C-E-R is that it could lead to rationing and interfere with the doctor-patient relationship, Baucus said the opposite is true. And he says the new Institute will have strong oversight.

BAUCUS AX: "I will use the full powers of the Finance Committee to see that the new Institute and health reform are implemented as Congress intended. Over the next years, we will hold hearings, engage stakeholders, and monitor the administration. And we will employ oversight agencies like the GAO to monitor and guide their progress as well."

NARR: Meanwhile, the feds aim to make it easier for consumers to appeal decisions made by their health insurance plans. New federal regulations set the standards both for internal appeals and appeals to independent third parties. The new rules mean that health plans must do these reviews faster, making decisions in 24 hours in urgent cases. And those who process appeals for insurance companies must avoid conflicts of interest. So plans can't reward employees with better pay or more vacations for denying claims. That's according to the U.S. Department of Labor.

NARR: And finally, stay tuned to see if Republicans get their wish-a chance to question the new head of the Centers for Medicare and Medicaid Services. Of course, that's Dr. Don Berwick. Even though the White House skipped the usual confirmation hearings with a recess appointment, GOP members of the House Energy and Commerce Committee have asked that committee's chairman to schedule a hearing with Dr. Berwick. They want to hear more about his plans for health reform implementation. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Free mammograms, colonoscopies, and well-child visits...all early benefits of health reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: While most provisions of the Affordable Care Act don't take effect until 2014, millions of Americans will begin getting free preventive screenings next year. The Obama administration laid out rules requiring all new health plans to cover preventive care without copays or deductibles, as long as the care is recommended by a set of government advisory groups. In an event at the White House, First Lady Michelle Obama said eliminating cost sharing will improve access. But as doctors know, she said, it's up to the patient to embrace prevention.

OBAMA AX: "Ultimately each of us needs to be a part of the solution on this one. Each of us needs to take responsibility for our own health. And each of us needs to use all the tools available to us to ensure that our kids get every possible chance to lead happy, healthy lives."

NARR: Physicians may be providing more preventive care next year, and that's not the only big change. 2011 is the first year doctors can get bonus payments from the government for using electronic health records. The feds issued so-called meaningful use rules and there's some good news. The requirements are easier to meet compared to proposals they floated earlier this year. But doctors will still need an electronic record that can document vital signs, demographics, send electronic prescriptions, and report on quality measures. Now for Medicare physicians who meet the standards in the first year, the payout is about 18,000 dollars...and up to 44,000 dollars over 5 years.

NARR: Meanwhile, the new CMS administrator Dr. Don Berwick was on hand in Washington to tout the new meaningful use rules. He was officially sworn in last week and says he's getting right to work. Likely to be on the top of the agenda--- working with Congress to sort out Medicare physician payments. Texas Republican Congressman Michael Burgess, who is an ob.gyn., said next year may be the time to fix this problem for good.

BURGESS AX: "You've got to be ready to do this because people have waited long enough. I've even heard the statement that this is one of the reasons that we lost the majority in 2006 was because we didn't tackle tough problems like this. Well, if we're going to show that we're different as a governing body in a new majority, after the first of the year, we've got to fix this."

NARR: Join us again next week to hear how health care could affect the mid-term elections. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Health reform implementation rolls on... without Congress. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: It's been a hot and humid summer in the Nation's Capital but that weather pales next to how steamed up Republicans are over the recess appointment of Dr. Don Berwick. He's the pediatrician and quality expert who President Obama nominated to be head the federal Center for Medicare and Medicaid Services. Now because Berwick was named while Congress was on Independence Day recess, the job is now his--without having to be confirmed by the Senate...without even a hearing. But Dr. Kavita Patel, who heads up the health policy program at the New America Foundation, said Dr. Berwick can repair a damaged relationship with lawmakers.

PATEL AX: "There will be some members of both the Democratic and Republican caucus that never got a chance to really to talk to Don and get to know him. So the downside is that that process that happens as a result of a hearing, and the questions during and after a hearing, is not going to take place. But I do think that Don and those of us who have worked with him and know him, we're very confident that he will establish those relationships in the very near future and will make up for that time that was lost in the questioning process."

NARR: It's not just personnel matters that are keeping the administration busy. Officials at the Health and Human Services department just launched healthcare.gov. It's where the public can find a range of coverage options. And the government rolled out a Pre-existing Condition Insurance Plan -that's a state-by-state program to cover U.S. residents who haven't been able to get insurance because of pre-existing conditions. In addition, some 300,000 Medicare beneficiaries who have entered the Part D donut hole will soon find $250 rebate checks in their mailboxes.

NARR: But for doctors, a big concern remains what will Congress do about Medicare payments come the end of November. The temporary 2.2 percent pay increase expires November 30, just after the mid-term elections. At that point Congress will have to act to make sure the required 21 percent cut does not go into effect. House Republican Dr Michael Burgess said it's unlikely that legislators will give physician fees much thought during that so-called lame duck session.

BURGESS AX: "That's generally a fairly contentious time... people are generally still mad at each other about the elections and it's very doubtful that... at least in my mind -- I'm just speaking for myself - it's very doubtful that a meaningful long term policy can be crafted in that tight little window after the election before November 30th."

NARR: Burgess said he expects another temporary patch to the physician pay problem until the next Congress convenes in January. But the congressman, who is also an ob.gyn., added that after that, it'll be time for Congress to fix the Medicare pay formula once and for all.

NARR Be sure to stay tuned all summer as we track the implementation of health reform and physician pay. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Physicians get a 6-month reprieve from Medicare cuts...Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The President has signed into law a measure reversing the 21% Medicare physician payment cut and replacing it with a 2.2% raise. That's through the end of November. With the politics done for now, Medicare officials now have to deal with the claims mess. Here's Mary Ellen Schneider with more:

SCHNEIDER: Here's the plan. Medicare officials are holding all claims to give their contractors a chance to update their software with the new rates. Medicare expects to start processing claims by July 1st. Now here's where things get complicated. If you have a June claim that was already paid under the 21% cut, you may need to contact your local Medicare contractor to request an adjustment. Under the law, Medicare pays whatever is lower-your charges or the Medicare fee schedule. So if you submitted charges that are the same or more than what Medicare is paying with this 2.2% increase-you're fine-the agency will automatically reprocess your claim. If your charges were lower, you need to request that adjustment. One more thing-don't just resubmit the claim. That could get you into trouble with Medicare.

NARR: Physicians groups welcomed the 6 months of breathing room but then echoed a refrain all too familiar in Washington. Congress must enact a permanent fix to the payment formula.

NARR: Meanwhile, the administration is touting the new health reform law and keeping the pressure on insurance companies. President Obama issued a warning to insurers last week at a White House ceremony. He said the law's new requirements shouldn't be used as an excuse to raise rates... and that the government will be watching.

NARR: It's not just insurance companies, but also large employers who are bracing for higher costs under health reform. James Gelfand, a policy analyst with the U.S. Chamber of Commerce, and he says that employers are steeling themselves for cost increases in two waves over the next few years. That's one in 2011 and another in 2014 when more health reform requirements kick in.

GELFAND AX: "What you're seeing from employers and what I'm hearing from employers is that basically they're hunkering down, it's a siege mentality, it's a bunker mentality, it's I'm going to have all these costs I know they're coming and I need to find a way to deal with it so how do you deal with costs you know you're about to incur? Well you try to have the money for it by a, not expanding, not hiring, not increasing people's wages, not creating jobs."

NARR: Gelfand also said that there's a strong possibility that employers may simply stop providing employee health insurance and instead pay a $2,000 per uncovered worker fine--rather than pay higher premiums.

NARR: Congress is getting ready to take a break for the Forth of July holiday and so are we. Join us again on July 12th for more on health reform implementation. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The 21% Medicare pay cut is in effect. But for how long? Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: After a week of tense debate, the Senate failed to stop the Medicare pay cut before it went into effect last Friday. But ours later, they passed a 6 month fix. Here's Mary Ellen Schneider to explain:

SCHNEIDER: As of Friday morning, the outlook for physician pay was pretty dim. Senate Democratic leaders had pushed hard to get a vote on a bill to stop the cut, among other things. But their efforts came to nothing. They failed to get the 60 votes needed to end debate and proceed to a vote on the bill. Then, in a surprise move, the 6 month fix was pulled out of that bill and passed alone. That measure still must pass the House and be signed by the President. Assuming there are no snags along the way, doctors will get a 2.2% raise through the end of November. That increase will be retroactive to June 1st to cover any claims processed at a lower amount.

NARR: None of this is certain of course. House Speaker Nancy Pelosi has said she has no interest in passing the 6-mont extension until the Senate acts on a broader jobs package. More on that later this week.

Doctors, not surprisingly, are frustrated and angry over the uncertainty of Medicare pay rates. Their ire was evident at the American Medical Association's annual policy meeting in Chicago last week. AMA delegates voted for so-called balanced billing - that is, letting doctors bill patients for costs that Medicare does not cover. Right now Medicare doesn't allow that. Policy experts, however, called the idea dead on arrival in Congress. And it could backfire by alienating AA R P, which has supported doctors in their struggle to get Medicare pay fixed.

NARR: In better news for doctors, the White House last week released 250 million targeted at boosting the primary care work force. About 168 million dollars will be used to train 500 new primary care doctors by 2015. The rest funds a new generation of primary care-oriented nurse practitioners and physician assistants. The Administration says there will be 16,000 new primary care providers in 5 years-- but that's 5,000 short of what's needed. Dr. Lori Heim of the American Academy of Family Physicians said the boost is welcome but more must be done.

HEIM: "It's a good start. If this were the only thing that came out it would not be enough. But I see this as the first in a sequential effort to increase the workforce."

NARR: Dr. Heim said next steps should include getting more students interested in primary care and finding ways to encourage primary care doctors to stay in practice.

NARR: With uncertain Medicare payments, staying in practice has become an increasingly dicey proposition. Look for physicians to keep the pressure on Congress for a permanent change to the Medicare physician payment formula. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

Another week gone by and still, there's no action on physician pay. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The Senate is back from vacation but still has not been able to agree on a plan to reverse the 21% Medicare physician pay cut. Here's Mary Ellen Schneider with more:

SCHNEIDER: The word on Capitol Hill is that the Senate will soon vote on a bill to temporarily stop physician pay cuts under Medicare. The House has already done its work and voted in May to give doctors small pay increases for the next year-and-a-half. But senators still do not agree on other elements of the bill. Doctors aren't happy about the delay but there's not much they can do except wait.

NARR: Meanwhile, on Monday, Medicare officials said they would hold off until the end of the week instituting that 21% cut...giving the Senate a few more days to pass the bill that avoids it.

NARR: Even President Obama is prodding the Senate to get the pay fix done. During a town hall meeting with seniors, the President said doctors need immediate relief to keep their doors open. The president also said the system needs an overhaul so that doctors get paid for providing quality, not quantity.

OBAMA AX: (:33 sec): "So there are adjustments we need to make over the long-term in how we reimburse doctors. But what we shouldn't do is have this guillotine hanging over their heads every year where they're having to figure out, am I going to get reimbursed or is suddenly my income going to drop by 20 percent? Because what will happen is, more and more people will say, I don't want to be a Medicare doctor. I don't want to be a primary care physician for somebody on Medicare, because it's going to make my income unstable. That's something that we've got to fix."

NARR: The Commonwealth fund had a message for the president….Get on with it! The Washington DC-based think tank pushed the president to get the government moving forward on concepts like patient-centered medical homes and bundled payments if payment reform is going to save money and help patients. And that's where the Center for Medicare and Medicaid Innovation comes in. The new office was created by the Affordable Care Act and will be up and running next year. And it can't come soon enough, according to the Commonwealth Fund analysts.

NARR: Finally, the American Medical Association will convene its annual policy meeting in Chicago this weekend and payment reform and pay cuts are sure to dominate the conversation. We'll have more on that and on the Senate's vote next time. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Doctors go public with their outrage over Medicare pay cuts. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The American Medical Association is furious that the Senate did not stop the 21% cut in Medicare payments that took effect on June 1st. Now doctors are looking to make those senators sweat. The AMA is spending millions of dollars on ads to tell patients that senators went on vacation instead of dealing with a Medicare payment crisis that threatens their access to care. The AMA's president, Dr. James Rohack, said Congress's refusal to address the crisis will have dire consequences.

Rohack AX: "It signals that Medicare and TriCare are no longer reliable programs for patients or for physicians."

NARR: Even if Congress does agree to boost doctors' pay for a few years, physicians still might not want to take care of Medicare patients. That's according to an AMA survey of more than 9,000 doctors. In the online poll, 42% of physicians said that they would stop seeing new Medicare patients even if there was a 3 to 5 year fix like the one Congress is debating now. About a quarter said they wouldn't see any new Medicare patients, no matter what.

NARR: Meanwhile, another group of doctors registered their displeasure with the health reform law, filing suit last week in Texas. Here's Alicia Ault with more.

AULT: Under the Affordable Care Act, Medicare will not pay for treatment at doctor-owned hospitals that are built or expanded after the end of this year. Physician Hospitals of America and the Texas Spine and Joint Hospital are crying foul over that portion of the law. They claim that that prohibition, which applies only to hospitals owned by doctors, is a violation of equal protection and due process. And they argue physicians should not be treated as a different class of citizens.

NARR: That suit will be closely watched by traditional hospitals, which have always viewed physician-owned facilities as a threat.

NARR: Back in Washington, the Obama administration is likely to win back some points with doctors in another arena. HHS is ready to start giving money to states that want to participate in a test of the new medical home concept. The agency said it will make awards to six states for the Advanced Primary Practice Demonstration program. The government wants to use the test to prove that the advanced primary care model--favored by internists and family doctors--can improve health quality and, at the same time, cut cost.

NARR: Congress gets back to work this week and the Senate is supposed to take action on the bill that would avoid Medicare pay cuts for the next 19 months. Meanwhile, still no word on when the President's nominee to head Medicare and Medicaid will be confirmed, though. Stay tuned for more on those stories next week. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Physician pay cuts take effect, but a controversial rule is delayed. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Senators left Washington for a Memorial Day break without voting on a bill to delay physician fee cuts. However, the House did approve a 19-month delay just before they left for the recess. Technically, the lack of a Senate bill means doctors will be paid 21 percent less to treat Medicare patients, starting on june first. Here's Alicia Ault with more.

AULT: The House vote follows weeks of debate on a potential short-term or temporary fix for Medicare's Sustainable Growth Rate, or SGR. At one point lawmakers considered passing a five-year solution to the SGR problem. But concerns about the deficit led fiscally conservative Democrats and Republicans to scale back. Meanwhile, doctors may not feel the 21% cut right away. Medicare officials said they are holding claims for the first 10 days of June, just in case Congress agrees on a more-lasting SGR solution soon.

NARR: There is some good news for doctors. The Federal Trade Commission has delayed enforcement of the so-called Red Flag Rule, which aims to protect consumers from identity theft. The medical community has been working for over a year to get either Congress or the courts to step in and exempt physicians. The doctors think the rule is burdensome, and shouldn't apply to them at all. While the Red Flags Rule actually is part of a law targeted at banks and creditors, the FTC says that it applies to any one or any business that allows customers to delay payment, and that includes a lot of doctors. As of now, the rule goes into effect next year.

NARR: Meanwhile, the Obama Administration is putting more emphasis on eliminating waste and going after fraud. They're making it a big focus of the Affordable Care Act. Medicare is trying to develop ways to weed out potentially false or fraudulent claims. That means that physicians will undergo more scrutiny when they submit Medicare claims. But Dr. Peter Budetti, a Medicare official, said last week that the system is being designed to trip up the bad actors, not legitimate health care providers.

BUDETTI AX: "We're developing objective criteria for what our risk exposure is and there are going to be categories of uh, along that spectrum and if people uh are legitimate providers that have been in business for a long time and we've never had any problem with them, they're gonna fall into the lowest risk category where our level of scrutiny is gonna be appropriate, but it's gonna be at the lowest end."

NARR: Physicians, hospitals and suppliers who get a higher risk rating will receive more attention, according to the agency.

NARR: The Obama Administration meanwhile is moving quickly to put reform elements into place, but opponents in the GOP aren't resting. Last week, they began to follow through on a vow to repeal health reform, with House members introducing another bill to replace the Affordable Care Act with a Republican plan.

NARR: Stay tuned as we follow that legislation and the fate of the physician fee cuts. And that's the Policy & Practice Podcast. I'm Todd Zwillich.