Podcasts about sustainable growth rate sgr

Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health. He joined NYU Langone Medical Center in 2008 as Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation after serving as Vice Chairman of Rehabilitation Medicine at Mount Sinai School of Medicine. He serves on numerous medical advisory boards and is a peer reviewer for several scientific journals. He has authored numerous chapters and peer-reviewed publications, and has participated in both federally- and industry-sponsored research. His medical degree is from the University of Medicine & Dentistry of New Jersey and he completed his residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation Medicine. PART 1 In Part 1 of his presentation, Dr. Flanagan discussed the value that physical medicine and rehabilitation (PM&R) add to health care.His objective in this session is to give an overview of health care reform and its impact on PM&R. Many changes have occurred since he began practicing medicine three decades ago. Health care reform is real. From 1960 to 2010, wages and GDP increased, but nowhere close to the enormous rise in health care expenditures, which are not sustainable. Also, we no longer can claim that we have the best health outcomes compared to other nations. Recognizing that health spending could no longer continue at such a rapid pace, the government came up with something called the Sustainable Growth Rate (SGR) to limit the outlandish expansion of health care costs. The attempt never achieved what was intended and Congress terminated the SGR in 2015. It was replaced by MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which redefined how physicians would be reimbursed and it is based on quality measures that they would have to meet. The objective is to achieve the triple aim of health care reform: improve health care quality, produce better outcomes, and improve the patient experience. A quadruple aim includes improving the satisfaction of providers. He indicated that management of post-acute care is of importance and that PM&R is uniquely situated to be involved in achieving the triple aim.  It can do so by focusing on patient-centered coordinated care that is comprehensive across the entire continuum. PART 2  Listeners to Part 1 of Dr. Flanagan’s presentation may recall that he discussed health reform efforts to control health care costs and how the provision of physical medicine and rehabilitation (PM&R) services has a unique role to play in achieving health reform’s triple aim. In Part 2, his comments had a focus on intensive care unit patients, a group associated with large health care costs and one not usually associated with the provision of rehabilitation services. What about safety? It’s feasible, but is it wise? Should we get folks up and walking who are so critically ill? Aren’t we putting them at risk of all sorts of bad things from happening? It is safe and the outcomes are fine and there is research to prove it. We are enhancing mobility, decreasing the number of days patients are on ventilators, and in some cases, not only are we not causing worse mortality, we are decreasing mortality. If you are doing all of this, the last question is what about costs? Despite increasing the use of PT, OT, and Speech staff, by getting patients out of the hospital faster, there is a cost savings. A pilot study was done at NYU to look at what happens to patients after they left the hospital to see if there were any additional savings. The results show that it was possible to reduce hospitalization, reduce the average direct cost per day, and there was a significant increase in the proportion of patients who were discharged to the community with no services at all. The latter outcome represented an overall cost savings for the health system. He also provided information about something that is relatively new and what they are working on at NYU, which is site neutral payments. A question and answer period followed his presentation.

Dr. Steven Flanagan is Howard A. Rusk Professor of Rehabilitation Medicine and Chairperson of the Department of Rehabilitation Medicine at NYU Langone Health. He joined NYU Langone Medical Center in 2008 as Professor and Chairman of Rehabilitation Medicine and Medical Director of Rusk Rehabilitation after serving as Vice Chairman of Rehabilitation Medicine at Mount Sinai School of Medicine. He serves on numerous medical advisory boards and is a peer reviewer for several scientific journals. He has authored numerous chapters and peer-reviewed publications, and has participated in both federally- and industry-sponsored research. His medical degree is from the University of Medicine & Dentistry of New Jersey and he completed his residency at Mt. Sinai Medical Center/Cabrini, Rehabilitation Medicine. PART 1 In Part 1 of his presentation, Dr. Flanagan discussed the value that physical medicine and rehabilitation (PM&R) add to health care.His objective in this session is to give an overview of health care reform and its impact on PM&R. Many changes have occurred since he began practicing medicine three decades ago. Health care reform is real. From 1960 to 2010, wages and GDP increased, but nowhere close to the enormous rise in health care expenditures, which are not sustainable. Also, we no longer can claim that we have the best health outcomes compared to other nations. Recognizing that health spending could no longer continue at such a rapid pace, the government came up with something called the Sustainable Growth Rate (SGR) to limit the outlandish expansion of health care costs. The attempt never achieved what was intended and Congress terminated the SGR in 2015. It was replaced by MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which redefined how physicians would be reimbursed and it is based on quality measures that they would have to meet. The objective is to achieve the triple aim of health care reform: improve health care quality, produce better outcomes, and improve the patient experience. A quadruple aim includes improving the satisfaction of providers. He indicated that management of post-acute care is of importance and that PM&R is uniquely situated to be involved in achieving the triple aim.  It can do so by focusing on patient-centered coordinated care that is comprehensive across the entire continuum. PART 2  Listeners to Part 1 of Dr. Flanagan’s presentation may recall that he discussed health reform efforts to control health care costs and how the provision of physical medicine and rehabilitation (PM&R) services has a unique role to play in achieving health reform’s triple aim. In Part 2, his comments had a focus on intensive care unit patients, a group associated with large health care costs and one not usually associated with the provision of rehabilitation services. What about safety? It’s feasible, but is it wise? Should we get folks up and walking who are so critically ill? Aren’t we putting them at risk of all sorts of bad things from happening? It is safe and the outcomes are fine and there is research to prove it. We are enhancing mobility, decreasing the number of days patients are on ventilators, and in some cases, not only are we not causing worse mortality, we are decreasing mortality. If you are doing all of this, the last question is what about costs? Despite increasing the use of PT, OT, and Speech staff, by getting patients out of the hospital faster, there is a cost savings. A pilot study was done at NYU to look at what happens to patients after they left the hospital to see if there were any additional savings. The results show that it was possible to reduce hospitalization, reduce the average direct cost per day, and there was a significant increase in the proportion of patients who were discharged to the community with no services at all. The latter outcome represented an overall cost savings for the health system. He also provided information about something that is relatively new and what they are working on at NYU, which is site neutral payments. A question and answer period followed his presentation.

ASN Manager of Policy and Government Affairs, Rachel Meyer, speaks with ASN Policy Associate, Mark Lukaszewski, about current efforts to repeal the Sustainable Growth Rate (SGR) formula and what ASN members can do to help get Congress to act.

ASN Manager of Policy and Government Affairs, Rachel Meyer, speaks with ASN Policy Associate, Mark Lukaszewski, about current efforts to repeal the Sustainable Growth Rate (SGR) formula and what ASN members can do to help get Congress to act.

ASN Manager of Policy and Government Affairs, Rachel Meyer, speaks with ASN Policy Associate, Mark Lukaszewski, about current efforts to repeal the Sustainable Growth Rate (SGR) formula and what ASN members can do to help get Congress to act.

ASN Manager of Policy and Government Affairs, Rachel Meyer, speaks with ASN Policy Associate, Mark Lukaszewski, about current efforts to repeal the Sustainable Growth Rate (SGR) formula and what ASN members can do to help get Congress to act.

This episode highlights the bills that passed the House of Representatives in March, including a bill that allows toxic mountaintop removal waste to be dumped in streams, a bill that skips environmental reviews for new nuclear power plants, a bill that wasn't meant to become law but could screw over every government employee if it did, a bill that prevents the government from managing water rights, multiple bills to chip away at ObamaCare, and more. Bills Presented in This Episode Every one of these bills passed the House of Representatives in March, 2014 and is now awaiting action in the Senate. HR 311: “Farmers Undertake Environmental Land Stewardship Act” FUELS Act Sponsored by Rep. Eric “Rick” Crawford of Arkansas Relaxes the EPA rule that requires farms install spill prevention equipment if they store oil on their properties. This bill became law as part of the Water Resources Reform and Development Act, although with different numbers. The previous law said that a farm would need to install spill prevention equipment if they stored more than 1,320 gallons of oil on their property and would have to have that equipment inspected and certified by an engineer if they stored more than 10,000 gallons of oil. The new law says that the farm must get oil spill prevention equipment if they store more than 6,000 gallons of oil on their property and must have that equipment inspected and certified by an engineer if they have over 20,000 gallons of oil. H.R. 311 would have allowed farms to store up to 42,000 gallons of oil before they would have to have oil spill prevention equipment installed and certified by and engineer. The author of H.R. 311 was Rep. Rick Crawford of Arkansas; he has taken over $278,000 from the crop production and basic processing industry. H.R. 938: United States-Israel Strategic Partnership Act of 2014 Sponsored by Ileana Ros-Lehtinen of Florida Would add Israel to a list of countries that gets approved faster for weapons shipments from the United States. Title II: Takes a $2 million a year grant program for renewable energy research and development and shifts its money towards natural gas. Ileana Ros-Lehtinen's top contributor is the "Pro-Israel" lobby, which has given her over $893,000. The bill passed 410-1. Additional Information: Analysis: Israeli natural gas fields hold big promise for Noble Energy, Reuters, February 10, 2014. HR 1459: Ensuring Public Involvement in the Creation of National Monuments Act Sponsored by Rob Bishop of Utah Changes the rules for creating a National Monument. Requires environmental reviews of proposed National Monuments. The President can only create one National Monument per state per term; any additional National Monument declarations must be created by Congress. Rep. Rob Bishop’s campaign’s top contributing industry for the upcoming election is the oil and gas industry, which has given him $22,000. In total, the oil and gas industry has given Rep. Rob Bishop over $150,000. Another industry that benefits from this bill is real estate, Rep. Rob Bishop's fourth most generous contributing industry, which has given him over $100,000. This bill had the closest vote of the month, passing 222-201. HR 1814: Equitable Access to Health and Care Act (EACH Act) Sponsored by Aaron Schock of Illinois On Monday, June 30, the Supreme Court ruled that corporations can pick and choose what is included in their employee’s health coverage, so long as they say that that coverage is against the owners' religion. This ruling means that H.R. 1814 would have far wider implications than originally intended if it were to become law. HR 1814 let’s people get out of buying health insurance entirely if they say their “sincerely held religious beliefs” say they can’t get medical care. If someone went to the doctor that year voluntarily, the exemption would be nullified. There’s no penalty for lying. After the Supreme Court decision, if H.R. 1814 were to become law, corporations might be able to get out of providing for their employees by claiming that doing so is against their religion. The bill passed overwhelmingly in March, without a recorded vote, but it's future now looks bleak in the Senate. H.R. 2641: Responsibly and Professionally Invigorating Development Act (RAPID Act) Sponsored by Rep. Tom Marino of Pennsylvania Prohibits more than one environmental impact statement and one environmental assessment per project. Allows the company applying for a permit to conduct that environmental review. Lets the Federal government, at the company’s request, accept an environmental analysis that was prepared under State laws; the State laws have to be “substantially equivalent to NEPA” - not entirely, meaning that the Federal government can accept environmental studies that are not as stringent as NEPA. The Federal government can use the environmental analysis of a completely different but similar project in “geographical proximity” that was prepared within the last five years. “Geographical proximity” is not defined. All project reviews must be done at the same time. If other agencies are supposed to be involved in the environmental study process. they will have 30 days to respond to the lead agency or forever hold their peace. The other agencies won’t be allowed to participate or even submit comments if they didn’t respond in those first 30 days. Once a project schedule has been created, the lead agency is not allowed to respond to or include any NEPA document, comment, or new information that was submitted outside the time allotted for environmental analysis in the schedule. Sets time limits for environmental impact statements and public comment periods. If the lead agency doesn’t meet these deadlines, the permit is deemed approved. The permit can not be reversed by any agency or the courts. Bars judicial review of Federal permits, with a few narrow exceptions Representatives Quoted in This Segment (in order of appearance): Rep. Tom Marino of Pennsylvania Rep. Sheila Jackson Lee of Texas HR 2824: Preventing Government Waste and Protecting Coal Mining Jobs in America Sponsored by Bill Johnson of Ohio Forces the States to comply with a rule that allows the waste from mountaintop removal for coal mining operations to be dumped into rivers and streams. The rule was implemented in the last days of the Bush Administration and was recently thrown out by the courts because it didn't comply with the Endangered Species Act. Bill Johnson, the author of this gift to the coal industry, has taken over $200,000 from the mining industry. The bill passed 229-192. Representatives Quoted in This Segment (in order of appearance): Rep. Rush Holt of New Jersey Rep. Jim Moran of Virginia Rep. Bill Johnson of Ohio Rep. Alan Lowenthal of California HR 3189: Water Rights Protection Act Sponsored by Rep. Scott Tipton of Colorado This bill prohibits the Federal government from requiring companies operating on public land to turn over their water rights as a part of their lease renewals. The bill was written to settle a dispute over a Forest Service directive that would have required ski resorts operating on public land to turn over their water rights to the government in order to keep operating on public land. The Forest Service had already retracted that directive at the time this bill passed. The bill however, would prohibit the entire Department of Agriculture and the entire Department of the Interior from requiring the relinquishment of water rights as part of a permit to operate on public land, meaning the bill would effect far more than just ski resorts. The bill passed 238-174. No Republicans voted against it. Witnesses quoted from the House Natural Resources Committee's Subcommittee on Water and Power's hearing from October 10, 2013 (in order of appearance): Tony Willardson, Executive Director of the Western States Water Council David Corbin, Vice President of the Aspen Skiing Company Glenn Porzak, Attorney for the National Ski Areas Association Representatives Quoted in This Segment (in order of appearance): Rep. Grace Napolitano of California HR 3826: Electricity Security and Affordability Act Sponsored by Rep. Ed Whitfield of Kentucky The EPA will be not be allowed to enact any standard on fossil fuel powered electric utilities that regulates emissions of carbon dioxide, methane, nitrous oxide, and a few other gases unless at least 6 utilities have already been meeting the standard for over a year; no results of demonstration projects can be included. Prohibits some specific proposed EPA rules from ever going into effect. Rules enacted by the EPA to set emission standards on fossil fuel utilities can’t go into effect until Congress passes a Federal law to set the enactment date. Ed Whitfield’s second highest contributor over the course of his career has been electric utilities; he’s taken over $614,000 from them. Electric utilities are his top contributor for the upcoming 2014 election; he’s taken over $157,000 and counting for this election alone. Ed Whitfield has also taken almost half a million over the course of his career from the oil and gas industry, over $100,000 of that for this upcoming election. The bill passed 229-183. HR 4015: SGR Repeal and Medicare Provider Payment Modernization Act of 2014 Sponsored by Michael Burgess of Texas This bill repeals the Sustainable Growth Rate (SGR) method of paying doctors who treat Medicare patients. The SGR rate ties the doctors' payments to the growth of the economy, which has short changed the doctors as medical costs have risen and the economy has remained flat. In it’s place, HR 4015 establishes what they call a “merit-based incentive payment system” that would come into effect on January 1, 2018. It creates a complicated system of scoring doctors based on their performance. Section 10, however, waives the tax penalty for not buying health insurance until 2019. This provision will kill the bill in the Senate. The bill passed 238-181. No Republicans voted against it. HR 4118: SIMPLE Fairness Act Sponsored by Rep. Lynn Jenkins of Kansas Delays the tax penalty assessed if you fail to buy health insurance for one year. The Congressional Budget Office determined that the result will be that one million fewer Americans sign up for health insurance over the next few years, with half of those being poor people eligible for Federal subsidies. The government would save a few billion over the next ten years, therefore, by not giving health insurance to poor people. Rep. Lynn Jenkins top five contributing industries include both health professionals and insurance. She’s taken over $300,000 from both. Representatives Quoted in This Segment (in order of appearance): Rep. Lynn Jenkins of Kansas Rep. Jim McDermott of Washington HR 4138: ENFORCE the Law Act of 2014 Sponsored by Rep. Trey Gowdy of South Carolina Allows the House of Representatives, the Senate, or the Congress as a whole to to “bring civil action” against another part of the government if Congress doesn’t think that part of the government is “faithfully executing the law” Allows either part of Congress to sue over the actions of the Executive branch, any department or agency or “any other officer or employee” of the United States for formal or informal policies, practices or procedures. Before Congress can file these civil suits, Congress needs to pass a resolution. After the lawsuit is filed in a district court, the rules are that the lawsuit will be heard by a three-judge court and their decision can only be appealed directly to the Supreme Court. This bill was presented as a solution to the "problem" of an Executive Branch that refuses to enforce the law. This bill, however, is so broadly and carelessly written that it appears to allow Congress to sue any part of the government, individual employees included, if Congress determines they have not "faithfully executed the law." [caption id="attachment_1453" align="aligncenter" width="625"] Stars of the "President Obama Sucks" montage[/caption] The only clear winners if this bill became law are the lawyers who would get to argue these civil cases. The author of the bill, Rep. Trey Gowdy, is a lawyer. Trey Gowdy’s most generous contributing industry are lawyers and law firms, which have given him over $188,000 during his two terms in Congress. The bill passed 233-181, with the support of every, single Republican. It stands no chance in the Senate. Representatives Quoted in This Segment (in order of appearance): Rep. Bob Goodlatte of Virginia Rep. Martha Roby of Alabama Rep. Jeff Duncan of South Carolina Rep. Richard Nugent of Florida Rep. Ted Poe of Texas Rep. Trey Gowdy of South Carolina Rep. Jim McGovern of Massachusetts Ignored Subpoena Rep. Chaka Fattah of Pennsylvania informed the House of Representatives that he is not going to comply with a subpoena. It's not clear exactly what the subpoena was for but he has been under Federal investigation for various improprieties since 2007. Additional Information: Pennsylvania Rep. Chaka Fattah vows to fight federal subpoena, Washington Times, March 13, 2014. Music Presented in This Episode March of the Pigs by A Thousand Suns (found on Music Alley by mevio) Intro and Exit Music: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)  

In this episode, we look at all the important bills that become laws since the start of 2014, including a law that might cost you thousands of dollars per year, a law that ends public financing of political party nominating conventions, and a law that President Obama openly intends to ignore. We also discuss the resignation of Rep. Rob Andrews of New Jersey from the House of Representatives.  Laws Discussed in This Episode  S. 25: “South Utah Valley Electric Conveyance Act” Introduced by Senator Orrin Hatch This law has nothing to do with the South Utah Valley Electric Service District. S.25 changes the cost of living adjustment included in the budget agreement that was created after the shutdown ended which cut cost of living adjustments to pensions paid to veterans by 1%, which would short them each tens of thousands of dollars over the course of their lives. Now, we’re going to short change military members who enroll on or after January 1, 2014. Makes changes to which fund we use to pay Medicare doctors. Pays for all of this by extending the sequester for another year. It’ll now go through 2024. HR 4302: "Protecting Access to Medicare Act" Introduced by Rep. Joe Pitts of Pennsylvania In 1997, Congress invented the “Sustainable Growth Rate” (SGR) system for paying Medicare doctors. It tied the amount of money doctors get for Medicare doctors to projected growth of the economy. Since health care costs have skyrocketed at the same time that the economy has gone sour, doctors would see a huge pay cut of 24% if the SGR system of payment were used. H.R. 4302 delays the cuts to Medicare doctors for another year. Section 213 repeals the limitation on cost-sharing (deductibles) for employer-sponsored health plans for companies with 100 employees or fewer. It is retroactive to March 2010. HR 2019: “Gabriella Miller Kids First Research Act” Introduced by Gregg Harper of Mississippi Eliminates all public funding of “any major or minor” political party nominating convention. Authorizes - but does not appropriate - the money to go towards a ten year pediatric research fund NPR segment on H.R. 2019 S. 2195: Denys US admission to UN Reps who were spies or terrorists Introduced by Senator Ted Cruz of Texas and Rep. Doug Lamborn of Colorado Denies visas to United Nations representatives who have been “found to have been engaged in espionage activities or a terrorist activity.” This new law was designed to keep Iran’s representative to the United Nations out of the United States. The United States says that Hamid Aboutalebi was involved in the Iran hostage crisis in 1979. President Obama called the new law “advisory”, basically saying he has the right to waive it using his power to receive or reject ambassadors. President Obama claims that Bush set the precedent for waiving laws in this manner. S. 404: Green Mountain Lookout Heritage Protection Act Introduced by Patty Murray of Washington Green mountain lookout can’t be moved except for safety reasons S. 2183: Propaganda for Ukraine Introduced by Mitch McConnell of Kentucky Radio Free Europe/ Radio Liberty Incorporated and Voice of America will provide “news and information” to Ukraine & Ukraine’s neighboring countries We will conduct a “programming surge” broadcasting 24-7 to “target populations" We will “highlight inconsistencies and misinformation provided by Russian or pro-Russian media outlets” We will focus on areas dominated by Russian media We will put more reporters and “organizational presence” in eastern Ukraine We will “partner with private sector broadcasters” to create content and spread the word. We can use “jamming and circumvention technology to overcome any disruptions to service.” Congress is allowed to use $10 million of our money for this, if they appropriate the funds. Emergency Declarations President Obama continued national emergency declarations for "the situations" in: Cuba Zimbabwe Iran Somalia President Obama declared new national emergencies for situations in: Ukraine South Sudan Rob Andrews Resigns from Congress On February 18, Rep. Rob Andrews of New Jersey resigned from Congress, citing his family has the reason when the real reason was because he was under investigation by the House Ethics Committee. Read the House Ethics Committee Report Rob Andrews under investigation for, among other things: Spending over $16,000 of campaign funds to fly his family to a wedding in Scotland. Using campaign funds to fly himself and his daughter to Los Angeles six times in 2011 so that she could pursue an acting career in Hollywood. Using campaign funds to donate thousands of dollars to theaters that hired his daughter to appear in their productions. Earmarking over $1.5 million to the Rutgers University School of Law, where his wife is an Associate Dean. By resigning, Andrews made all these investigations go away because the House Ethics Committee said it lacks jurisdiction over ex-members. On May 5, Rob Andrews registered as a lobbyist based out of a Philadelphia law firm where his wife used to work. He will be lobbying on behalf of Merit Inc., which provides IT and security for private and public institutions including the EPA, National Park Services, U.S. Corps of Engineers, US Navy, US Army, the FAA, the Dept. of Justice, and the Dept. of Veterans Affairs. He will also be lobbying on behalf of the National Coordinating Committee for Multi-employer Plans, which proudly proclaims on it's website that “NCCMP influences virtually every piece of employee benefit legislation for the benefit of multi-employer plans.” Representatives Quoted in This Episode Rep. Adam Smith of Washington Rep. Joe Pitts of Pennsylvania Rep. Doug Lamborn of Colorado Music Presented in this Episode Working for America by Olio (found on Music Alley by mevio) None of the Above by David Ippolito (found on Music Alley by mevio) Intro and Exit Music: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)  

Michael Chernew is a professor of health care policy in the Department of Health Care Policy at Harvard Medical School. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. A. Alhassani, A. Chandra, and M.E. Chernew. The Sources of the SGR "Hole". N Engl J Med 2012;366:289-91.