Health Care Reform: Looking for Direction

Health system reform legislation has switched from the fast lane to park as Congressional leaders ponder what direction they might want to take. The NCMS remains committed to its long-standing position that changes are needed in health care delivery. As our recent member survey showed, most doctors want health system reform, but they do not support the legislation that is currently being debated in the U.S. House and Senate.

Physicians need to stay engaged so that health system reform remains on the front burner. As the NCMS has outlined in letters to the NC Congressional Delegation, there are provisions of HR 3590 that we feel should be kept and strengthened, if possible:

  • Health insurance market reforms
  • Coverage for prevention and wellness initiatives without co-payments or deductibles
  • Administrative simplification
  • Reduced overpayments to Medicare Advantage plans
  • Bonus payments and graduate medical education (GMS) expansion for primary care, but not at the expense of Medicare or GME slot reductions for other specialties
  • Expanded access to primary care and increases in rates for primary care, but not financing these changes by reductions in rates for specialist services
  • Implementation of health homes for patients with chronic conditions

Other sections of HR 3590 are inadequate and would damage patient care, and we urge physicians to encourage House and Senate members to support the following provisions:

  • Sustainability from a financial standpoint
  • Addition of a provision to establish a permanent replacement for Medicare’s sustainable growth rate (SGR) formula
  • Inclusion of incentives for states to enact meaningful tort reform that reduce defensive medicine costs and create savings that offset increased health insurance premiums
  • Elimination of provisions that would create an Independent Medicare Advisory Board with the power to mandate payment cuts for physicians
  • Elimination of provisions that would redistribute Medicare payments among physicians and providers based on untested and arbitrary treatment standards that do not improve the quality of patient care
  • Elimination of penalties for physicians who do not successfully participate in the Physician Quality Reporting Initiative (PQRI)
  • Elimination of provisions that create an unintended incentive to pay a fine for not having required insurance coverage
  • Elimination of the 5-percent excise tax on elective cosmetic surgical and medical procedures
  • Elimination of enrollment fees for Medicare
  • Continuation of supplemental federal medical assistance payments at 2009 levels for at least two more years, to ensure that access to care for Medicaid patients does not deteriorate any further
  • Addition of safeguards to the proposed demonstration projects to bundle payments for the provision of integrated care for Medicaid patients
  • Amending limitations on the participation of physician-owned hospitals in the Medicare and Medicaid programs

Further details about these provisions are found in the NCMS Guiding Principles to Health System Reform and letters sent to NC US House and Senate members, which can be accessed at

The NCMS stands firm in its pursuit of health system reform. We will continue to keep you informed through the Bulletin and at our website,, and we will continue to survey members to learn where you stand on health system reform issues. We appreciate your comments and urge you to contact your US Representative or Senators today and ask them to give health system reform the attention it needs so that you can deliver the kind of care your patients deserve.

Resources on health system reform are available in the health reform section of the NCMS Web page and on the Doctor to Doctor blog.

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