The Status of Health Reform

1. The Status of Health Reform Melanie Hobbs Director, Public Policy and Government Relations St.Vincent Health Tory Callaghan Castor Vice President, Government Relations Clarian Health Partners Updated December 14, 2009

2. Important Players • The White House • House “Tri-Committee” • House Speaker Nancy Pelosi • Ways and Means (Rep Charles Rangel – D., NY) • Energy and Commerce (Rep Henry Waxman – D., CA) • Education and Labor (Rep George Miller – D., CA) • Senate • Senate Majority Leader Harry Reid • Health, Education, Labor and Pensions (HELP Committee) – (Sens. Dodd & Harkin – D., Ct, IA) • Finance Committee - (Sen Max Baucus – D., Mont) • Ben Nelson • Olympia Snowe • Joe Lieberman • Blue Dog Democrats • The Congressional Budget Office • Industry Trade Groups

3. Next Steps: Senate Action Energy & Commerce Ways & Means Education & Labor Finance HELP Passed July 31 Passed July 16 Passed July 17 Passed October 13 Passed July 16 Three bills combined into one Two bills combined into one October 29 Reconciliation Regular Order November 18 Limited floor debate – One Day Two Amendments Considered; One Adopted Filibuster Limits on non-budget-related provisions Limited floor debate Unlimited floor debate November 7 Cloture (60 votes) HOUSE VOTE Passed 220-215 Full Senate vote on bill (simple majority to pass) HOUSE SENATE COMMITTEES Two bills to be combined into one FLOOR CONSIDERATION House-Senate Conference Committee

4. What the White House Wants

6. Increase Healthcare “Value” Reduce Costs Improve Quality Value-Based Purchasing Reduce Preventable Readmissions Reduce Hospital Acquired Conditions Bundled Payments Accountable Care Organizations Electronic Health Records Delivery System Reform The Goal Tactics Prerequisite

7. Public Opinion

8. The Role of Physical Therapists • APTA-Supported Policy Principles for Health Care Reform: • Systematic health care reform that provides: • Guarantee Issue • Guarantee Renewal • Guarantee Choice • Ensure that rehabilitation services, provided by licensed health care professionals, are an essential element of a standard benefits package in any proposal to reform the insurance delivery system. • Enact insurance reforms that: • Eliminate arbitrary limits on annual or lifetime benefits; • Prohibit cost shifting by increased co-payments, deductibles, and/or premiums; and • Ensure non-discrimination on benefits or providers. • Reform Medicare payment policies: • Permanently repeal the Sustainable Growth Rate (SGR) formula • Permanently repeal arbitrary outpatient therapy caps on services; and • Eliminate certification of the plan of care for patients to access outpatient physical therapy services.

9. The Role of Physical Therapists • APTA-Supported Policy Principles for Health Care Reform: • Ensure that policies regarding bundling payments meet the following criteria: • Bundled payments should not be implemented without evaluation of its feasibility as a payment model for post-acute care services. • Patient safeguards should be established to ensure patient choice and access to the full range and continuum of post-acute and outpatient care. • Post-acute care should be defined as Part A services within the first 30 days post discharge from an acute care hospital stay delivered by inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and/or long-term acute care hospitals. • Enhance initiatives to develop an adequate health care workforce. • Enable physical therapists to participate in current initiatives, such as the NHSC. • Expand federal funding for clinical education, fellowships, and faculty development in physical therapy. • Reduce unnecessary regulatory burdens on physical therapists to enhance efficiency and effectiveness in delivering health care to their patients at the right time and place.

10. Questions ?