If you've been tracking with this series, you're learning, along with me, that H.R.3200, also know as Obamacare, isn't a "reform" of America's health care system - it's a nearly complete government takeover.   

If your Representative is undecided, or favors Obamacare, call their DC office and ask to speak to someone knowledgeable about the bill. Ask questions. You're entitled to answers.  This bill represents over a trillion dollars in taxpayers' money.

Question 18: Section 1121, Sustainable Growth Rate Reform, Subsection (c), Limitation On Physicians' Services Included in Target Growth Rate Computation To Services covered Under Physician Fee Schedule, stipulates a change in the language of the Social Security Act in section 1848(f)(4)(A) which today reads as follows:    

 "(A) Services included in physicians' services.-The term ‘physicians' services' includes other items and services (such as clinical diagnostic laboratory tests and radiology services) specified by the Secretary, that are commonly performed or furnished by a physician or in a physician's office, but does not include services furnished to a Medicare+Choice plan enrollee."

Obamacare proposes to change the  language in the SSA bill to the following:

"(A) Services included in physicians' services.-The term ‘physicians' services' includes other items and services for which payment under this part is made under the fee schedule under this section, for services for practitioners described in section 1842(b)(18)(C) on a basis related to such fee schedule, or for services described in section 1861(p) (other than such services when furnished in the facility of a provider of services), but does not include services furnished to a Medicare+Choice plan enrollee."

Social Security Act 1842(b)(18)(C) reads: "A practitioner described in this subparagraph is any of the following: (i) A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)). (ii) A certified registered nurse anesthetist (as defined in section 1861(bb)(2)). (iii) A certified nurse-midwife (as defined in section 1861(gg)(2)). (iv) A clinical social worker (as defined in section 1861(hh)(1)). (v) A clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)). (vi) A registered dietitian or nutrition professional."

And, SSA Section 1861(p) refers to: "The term ‘outpatient physical therapy services' means physical therapy services furnished by a provider of services, a clinic, rehabilitation agency, or a public health agency, or by others under an arrangement with, and under the supervision of, such provider, clinic, rehabilitation agency, or public health agency to an individual as an outpatient..."

So what's the change?  Well, it looks like the physician services covered in the existing SSA is downgraded by the definition of "practitioner" as meaning one of the non-physician specialists in the SSA section 1842(b)(18)(C) list above.

Question 19: Section 1122, Misvalued Codes Under The Physicians Fee Schedule, offers a revision of SSA Sec. 1848 which includes adding this language:

"(i) In General.-The Secretary shall establish a process to validate relative value units under the fee schedule under subsection (b).

(ii) Components And Elements Of Work.-The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include furnishing a service and my include validation of the pre, post, and intra-service components of work." 

Question 20:  Section 1145, Treatment Of Certain Cancer Hospitals, proposes to add a paragraph (18) to section 1833(t) of the Social Security Act.  The addition pertains to specialized cancer hospitals. It reads:

"(18) Authorization Of Adjustment For Cancer Hospitals.- (A) Study.-The Secretary shall conduct a study to determine if, under the system under this subsection, costs incurred by hospitals described in section 1886(d)(1)(B)(v) with respect to ambulatory payment classification groups exceed those costs incurred by other hospitals furnishing services under this subsection as determined appropriate by the Secretary).

(B) Authorization Of Adjustment.-Insofar as the Secretary determines under paragraph (A) that costs incurred by hospitals described in section 1886(d)(1)(B)(v) exceed those costs incurred by other hospitals furnishing services under this subsection, the Secretary shall provide for an appropriate adjustment under paragraph (2)(E) to reflect those higher costs effective for services furnished on or after January 1, 2011."

So, what's 1886(d)(1)(B)(v) about? [WARNING: Skip this next part if you're not into the minutia of understanding cancer treatment options and go straight to the next "SO,".] Here's how that section reads in the Social Security Act:

"(I) a hospital that the Secretary has classified, at any time on or before December 31, 1990, (or, in the case of a hospital that, as of the date of the enactment of this clause, is located in a State operating a demonstration project under section 1814(b), on or before December 31, 1991) for purposes of applying exceptions and adjustments to payment amounts under this subsection, as a hospital involved extensively in treatment for or research on cancer,

(II) a hospital that was recognized as a comprehensive cancer center or clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of April 20, 1983, that is located in a State which, as of December 19, 1989, was not operating a demonstration project under section 1814(b), that applied and was denied, on or before December 31, 1990, for classification as a hospital involved extensively in treatment for or research on cancer under this clause (as in effect on the day before the date of the enactment of this subclause), that as of the date of the enactment of this subclause, is licensed for less than 50 acute care beds, and that demonstrates for the 4-year period ending on December 31, 1996, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E), or

(III) a hospital that was recognized as a clinical cancer research center by the National Cancer Institute of the National Institutes of Health as of February 18, 1998, that has never been reimbursed for inpatient hospital services pursuant to a reimbursement system under a demonstration project under section 1814(b), that is a freestanding facility organized primarily for treatment of and research on cancer and is not a unit of another hospital, that as of the date of the enactment of this subclause, is licensed for 162 acute care beds, and that demonstrates for the 4-year period ending on June 30, 1999, that at least 50 percent of its total discharges have a principal finding of neoplastic disease, as defined in subparagraph (E); and, in accordance with regulations of the Secretary, does not include a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital (as defined by the Secretary). A hospital that was classified by the Secretary on or before September 30, 1995, as a hospital described in clause (iv) shall continue to be so classified notwithstanding that it is located in the same building as, or on the same campus as, another hospital."