The following leaders of national healthcare trade associations, representing key healthcare constituencies, had a crucial role in shaping the healthcare reform law. Here are summaries of what each did on behalf of their members, how the law will affect their sector and each leader's 2008 compensation, where applicable.
Billy Tauzin, Pharmaceutical Research and Manufacturers Association
2008 compensation: $4.4 million
In 2004, as a Republican U.S. representative from Louisiana and chair of the House committee that oversees the drug industry, Mr. Tauzin raised eyebrows when he resigned from Congress two months after shepherding through the Medicare Prescription Drug Bill, only to become CEO of PhRMA. But after five years at the helm, Mr. Tauzin will be stepping down at the end of June, due to backlash among members over early deals he made with the Obama administration on healthcare reform.
PhRMA was an early supporter of healthcare reform because, as Mr. Tauzin explained to the New York Times, "We were assured [by the administration], 'We need somebody to come in first. If you come in first, you will have a rock-solid deal.' "
Although Mr. Tauzin was paid more than any other healthcare association executive, he may well have been worth it. True, drugmakers will have to contribute $85 billion in fees and lower payments from government programs in the first 10 years of reform, but Mr. Tauzin did manage to bring home some bacon. In addition to gaining tens of billions of dollars in new revenues from the newly insured, drug companies avoided calls for price controls and more regulation of drugs.
Karen Ignagni, America's Health Insurance Plans
2008 compensation: $1.9 million
Although AHIP never officially supported healthcare reform and strenuously fought a proposal for a government-run public insurance option, Ms. Ignagni played a leading role in shaping the law in backroom negotiations with the administration and Congress.
Understandably, she was a strong supporter of the insurance mandate, which is expected to bestow 16 million new customers on private insurers. She also viewed the universal mandate as a prerequisite for insurance market reforms, such as ending denials of coverage based on preexisting conditions. "Implementing reforms of the insurance market without a strong requirement that everyone participate will cause adverse selection and significantly increase costs for individuals and small businesses," she wrote in the Washington Post last October.
Ms. Ignagni was a strong advocate of cost-saving measures in the reform bill. "We believe the nation can bend the cost curve by 1.5 percentage points annually if reform includes system-wide efforts to reward best practices, shrink the wide variation in care, expand care coordination and equip doctors and patients to make decisions based on what works," she wrote in the Post piece.
Scott Serota, Blue Cross Blue Shield Association
2008 compensation: $3.9 million
Interviewed by the Nightly Business Report just after the reform law was signed, Mr. Serota did not act like an entrenched opponent. "Health care reform is now the law of the land and our job is to ensure that these reforms are implemented in a fashion that works for all Americans," he said.
While the Blues officially opposed the reform bill, a key provision in the final law furthers an important Blues objective, promoting clinical practice guidelines to save expenses by aligning all caregivers behind the same regimens. The law sets up "centers for comparative effectiveness," which sound a lot like a Mr. Serota's own vision of an independent institute on comparative effectiveness research. The institute, he wrote in 2007, would be "devoted exclusively to developing credible clinical information on the comparative effectiveness of new and existing medical procedures, drugs, devices and biologics."
Health insurers, however, were always thought to be the bad guys in the reform debate, and they ended up taking quite a few bullets in the final law. Payors will have to participate in state-supervised exchanges, which involve a lot of regulations, abide by new limits on how much an insurer can vary premiums for same policy, and accept reduced subsidies for Medicare Advantage managed care plans, to name just a few bullets. But thanks mainly to public mistrust, Congress backed away from the industry's nemesis, the public option, which would have drawn customers away. The insurance lobby also successfully fought off a lukewarm bid to repeal the industry's exemption from antitrust laws.
Rich Umbdenstock, American Hospital Association
2008 compensation: $2.0 million
The AHA under Mr. Umbdenstock began to build a "reform framework" in early 2006, anticipating it would be an issue in the 2008 election. "Extending coverage to as many people in this country as is possible is consistent with AHA policy," he told John Iglehart, editor of Health Affairs, last October. "We’ve called for coverage for all, paid for by all."
Mr. Umbdenstock even urged healthcare reform planners to abandon the current hospital payment system. "We do believe that the payment system will change and should change, that it’s got to move away from a reward for volume to a reward for quality, and to encourage greater teamwork and integration within the system in order to make it more of a true system, and to align the interests not only of the provider groups," he told Mr. Igelhardt. That vision sounds a lot like the law's call for accountable care organizations, which bring together hospitals, doctors and other providers in loosely knit organizations that coordinate all levels of care for each enrolled patient.
Mr. Umbdenstock also was able to stop excesses in reform planning. When the administration called for $228 billion from hospitals over 10 years, he spoke out. "This amount is untenable, just unacceptable for hospitals that have been hit by the downturn in the economy," he said. The amount was reduced to $155 billion in Medicaid funding over 10 years in the final law.
Chip Kahn, Federation of American Hospitals
2008 compensation: $2.3 million
In a little over 15 years, Mr. Kahn went from dealing the death blow to President Clinton's healthcare reform proposal to becoming one of the most loyal supporters of Mr. Obama's plan. When he was a lobbyist for the insurance industry, Mr. Kahn helped develop the "Harry and Louise" TV ads against Mr. Clinton's reforms. But in 2007, as leader of FAH, Mr. Kahn released a healthcare reform proposal that could serve as a prototype for the final law. FAH proposals like a universal mandate for health insurance and a Medicaid expansion found their way into the law.
"We are at one of those inflection points in history when healthcare reform is not only possible but desperately needed," Mr. Kahn said during the healthcare debate.
The federation seemingly bet big money by bringing in Mr. Kahn at his multi-million-dollar salary, but in many ways that bet succeeded. By jumping on the reform bandwagon, hospitals avoided a slew of proposals by reform planners. These included a minimum charity-care requirement for tax-exempt hospitals, cuts in indirect medical education subsidies for residency programs and hospital rates set at lower Medicare or Medicaid levels for the new health insurance exchanges. Hospitals also avoided being put under the control of a new rate-setting board for physicians and other providers.
J. James Rohack, American Medical Association
2008 compensation: not applicable
Dr. Rohack, who stepped down from his one-year term as president of the AHA on June 15, made healthcare reform his No. 1 issue and may live to regret it. Although the AMA never fully embraced reform, parsing its position as one of "support," not endorsement, the association was a valuable cheerleader. "While the final product is certainly not what we would have devised," Dr. Rohack said during the debate, "we strongly support the parts of this bill that are desperately needed by millions of Americans who are struggling to get or keep health-insurance coverage."
Dr. Rohack said the legislation lacked a number of pro-physician measures, such as decisive malpractice reforms and removal of the Medicare physician fee cuts. For these reasons, many physicians outright opposed the bill. When AMA's pro-reform stance was challenged by 10 medical societies at an AMA meeting last November in Texas, Dr. Rohack's home turf, the AMA president handily beat back the opposition in a lopsided vote favoring his position.
But the AMA's qualified support netted it only qualified achievements in the final law. Physicians will gain new patients, but many of them will be on Medicaid, which pays below cost. Primary care physicians and general surgeons will see an increase in Medicare pay, but specialists will not. Physicians will see an extension of incentive payments for Medicare quality reporting, but a new Medicare Payment Advisory Board that may unilaterally cut their fees. And Dr. Rohack's hopes of persuading Congress to enact any kind of permanent physician fee-fix seem very dim.
Joseph D. Zuckerman, MD, American Association of Orthopaedic Surgeons
2008 compensation: not applicable
Dr. Zuckerman's one-year term as AAOS president ended a little more than a week before President Obama signed the healthcare reform law. In the reform debate, the AAOS leader was always prefaced his criticisms of the bill by mapping out areas of common interest, such as universal access, insurance reforms and other provisions. That said, the AAOS came out bluntly against the reform bills at a time when the AMA and even the American College of Surgeons generally praised the legislation. Allied with the American Association of Neurological Surgeons, the AAOS organized a widespread uprising that included many surgical specialty groups.
The AAOS/AANS-led coalition declared it was more representative of physicians than the AMA. "America's Physicians DO NOT SUPPORT the current healthcare reform bill," the coalition stated in a release. "Physician organizations representing nearly 500,000 physicians (many more than the AMA) do not support the Patient Protection and Affordable Care Act." The coalition's specific concerns about the bill, however, were little different from the AMA's, covering the too-powerful payment advisory board, lack of meaningful tort reform, the ban on physician-owned hospitals and a continuing failure to pass a permanent fee-fix. One obvious difference was AAOS criticism of the law's extra funding for primary care physicians at the expense of specialists, but that was a topic the AMA, claiming to represent all physicians, was better off ignoring.
It didn't help that President Obama got off on the wrong foot – quite literally – with the orthopedic surgeons. Speaking in favor of preventive care over surgery last August, Mr. Obama said when a diabetic's foot is amputated, the surgeon charges Medicare $30,000-$50,000 and is "immediately" reimbursed. Stunned by the president's inflated idea of what orthopedic surgeons make (and what that might mean for reimbursement adjustments under healthcare reform), the AAOS immediately issued a corrective release. Actually, the release said, this procedure nets only around $700-$1,200 and payment is by no means immediate.
Charles Branch Jr., MD, North American Spine Society
2008 compensation: not applicable
Dr. Branch stepped down as NASS president last November. It's hard to believe that one of his last pronouncements as president, about the need to replace the sustainable growth rate formula causing the physician fee cuts, is still unresolved. "Replacing the SGR formula with a reasonable mechanism for updating Medicare physician fees is the first step toward maintaining appropriate access to specialty care," he said during the debate. An SGR fix was initially part of reform bill but was pulled out of the final version because it drove up the price tag of overall reforms. Lawmakers are still having a very difficult time swallowing the cost of a permanent fee-fix, estimated at $250 billion.
The NASS joined the AAOS coalition against the reform bill and shared many of the AAOS' concerns, such as reduced payments for specialists. "Specialists are continuing to lose more ground in the fees they receive for serving Medicare beneficiaries, while their practice costs steadily rise," Dr. Branch wrote in a letter to House Speaker Nancy Pelosi (D-Calif.) in July 2009. The letter said primary care providers received a pay raise in 2005 while payments for many specialty services were cut in 2008. Dr. Branch's plea didn’t went unheeded. The reform law provides a 10 percent Medicare bonus for many primary care physicians for the next five years and none for specialists.
The NASS had more luck limiting use of proposed comparative effectiveness research (CER). In his letter to Ms. Pelosi, Dr. Branch said NASS supports such research but added, "In no way should findings or recommendations of a CER body be tied to reimbursement decisions." The reform law creates the Patient-Centered Outcomes Research Institute and appropriates $210 million for patient-Centered Outcomes Research Trust Fund, but the law said the institute's findings should not be used to "deny coverage" in federal programs.
Molly Sandvig, Physician Hospitals of America
2008 compensation: $191,000
Next to the drugmakers, health insurers and hospitals, the physician-owned hospitals were small potatoes in the healthcare reform debate, resulting in a provision in the law to ban physician-owned hospitals, added at the behest of the hospitals. The PHA's only significant ally against the provision was the AMA, which was having problems just getting its own wish-list passed.
Nevertheless, Mr. Sandvig and her members were able to convince Congressional Democrats to move the deadline for implementing the ban to Dec. 31 of this year. The original House version would have started the ban retroactively on Feb. 1 and the Senate version originally called for an Aug. 1 deadline, which still left too little time for a hospital in construction to be up and running and get its Medicare certification. Although the Dec. 31 date was a significant coup, many projects still did to night have enough time and the March 23 effective date for a ban on any expansions of existing facilities was not changed.
The PHA filed a lawsuit against the ban in June. "It is truly illogical and unfortunate that at a time the government is supposedly attempting to increase access to care, it has chosen to stop the growth of many of the best hospitals in the country," Ms. Sandvig said in connection with the lawsuit.
Kathy Bryant, Ambulatory Surgery Center Association
2008 compensation: $170,000
In a recent interview on her role in the healthcare reform debate, Ms. Bryant recalled, "We held numerous meetings with the White House, CMS and members of Congress. In those meetings and in other communications with government officials, we made suggestions."
Her chief goal was to convince reform planners to use ASCs as a key strategy to reduce healthcare costs while upholding quality. But one can imagine what the powerful hospital lobby thought of that. Ms. Bryant, who is stepping down this year after 10 years of service, said her efforts were defeated. "Despite all of our hard work, healthcare reform, as enacted, does not in any significant way encourage or expand the federal government’s use of ASCs," she said in the interview.
Nonetheless, Ms. Bryant and other ASC leaders scored a small but important victory. The law changed implementation of a new productivity adjustment for ASCs by one year, thereby averting a lower payment and ensuring a higher base amount for future adjustments. "Essentially, the productivity index will cause payment updates beginning in 2011 and every year after to be lower," she told Becker's ASC Review. "Because of the ASC payment freeze and the method in which our inflation update is already factored, the productivity adjustment will have a disproportionate impact on ASCs."
She added that removing provisions from the reform law is just as important as adding them. "For example, ASC cost reporting was not included in the final legislation and other health sectors, such as home health, have experienced huge reductions that we were largely able to avoid," Ms. Bryant said.
The reform law may end up indirectly harming ASCs. For example, it generally makes healthcare more bureaucratic through structures such as the independent advisory board and could drive down payments by adding more Medicaid recipients. Enhanced federal funding will only temporarily raise Medicaid reimbursements. Meanwhile, ASC physicians will probably continue to have no meaningful professional liability reform or permanent Medicare fee-fix.
Note: 2008 compensation, the latest available, comes from IRS Form 990 filings.
Billy Tauzin, Pharmaceutical Research and Manufacturers Association
2008 compensation: $4.4 million
In 2004, as a Republican U.S. representative from Louisiana and chair of the House committee that oversees the drug industry, Mr. Tauzin raised eyebrows when he resigned from Congress two months after shepherding through the Medicare Prescription Drug Bill, only to become CEO of PhRMA. But after five years at the helm, Mr. Tauzin will be stepping down at the end of June, due to backlash among members over early deals he made with the Obama administration on healthcare reform.
PhRMA was an early supporter of healthcare reform because, as Mr. Tauzin explained to the New York Times, "We were assured [by the administration], 'We need somebody to come in first. If you come in first, you will have a rock-solid deal.' "
Although Mr. Tauzin was paid more than any other healthcare association executive, he may well have been worth it. True, drugmakers will have to contribute $85 billion in fees and lower payments from government programs in the first 10 years of reform, but Mr. Tauzin did manage to bring home some bacon. In addition to gaining tens of billions of dollars in new revenues from the newly insured, drug companies avoided calls for price controls and more regulation of drugs.
Karen Ignagni, America's Health Insurance Plans
2008 compensation: $1.9 million
Although AHIP never officially supported healthcare reform and strenuously fought a proposal for a government-run public insurance option, Ms. Ignagni played a leading role in shaping the law in backroom negotiations with the administration and Congress.
Understandably, she was a strong supporter of the insurance mandate, which is expected to bestow 16 million new customers on private insurers. She also viewed the universal mandate as a prerequisite for insurance market reforms, such as ending denials of coverage based on preexisting conditions. "Implementing reforms of the insurance market without a strong requirement that everyone participate will cause adverse selection and significantly increase costs for individuals and small businesses," she wrote in the Washington Post last October.
Ms. Ignagni was a strong advocate of cost-saving measures in the reform bill. "We believe the nation can bend the cost curve by 1.5 percentage points annually if reform includes system-wide efforts to reward best practices, shrink the wide variation in care, expand care coordination and equip doctors and patients to make decisions based on what works," she wrote in the Post piece.
Scott Serota, Blue Cross Blue Shield Association
2008 compensation: $3.9 million
Interviewed by the Nightly Business Report just after the reform law was signed, Mr. Serota did not act like an entrenched opponent. "Health care reform is now the law of the land and our job is to ensure that these reforms are implemented in a fashion that works for all Americans," he said.
While the Blues officially opposed the reform bill, a key provision in the final law furthers an important Blues objective, promoting clinical practice guidelines to save expenses by aligning all caregivers behind the same regimens. The law sets up "centers for comparative effectiveness," which sound a lot like a Mr. Serota's own vision of an independent institute on comparative effectiveness research. The institute, he wrote in 2007, would be "devoted exclusively to developing credible clinical information on the comparative effectiveness of new and existing medical procedures, drugs, devices and biologics."
Health insurers, however, were always thought to be the bad guys in the reform debate, and they ended up taking quite a few bullets in the final law. Payors will have to participate in state-supervised exchanges, which involve a lot of regulations, abide by new limits on how much an insurer can vary premiums for same policy, and accept reduced subsidies for Medicare Advantage managed care plans, to name just a few bullets. But thanks mainly to public mistrust, Congress backed away from the industry's nemesis, the public option, which would have drawn customers away. The insurance lobby also successfully fought off a lukewarm bid to repeal the industry's exemption from antitrust laws.
Rich Umbdenstock, American Hospital Association
2008 compensation: $2.0 million
The AHA under Mr. Umbdenstock began to build a "reform framework" in early 2006, anticipating it would be an issue in the 2008 election. "Extending coverage to as many people in this country as is possible is consistent with AHA policy," he told John Iglehart, editor of Health Affairs, last October. "We’ve called for coverage for all, paid for by all."
Mr. Umbdenstock even urged healthcare reform planners to abandon the current hospital payment system. "We do believe that the payment system will change and should change, that it’s got to move away from a reward for volume to a reward for quality, and to encourage greater teamwork and integration within the system in order to make it more of a true system, and to align the interests not only of the provider groups," he told Mr. Igelhardt. That vision sounds a lot like the law's call for accountable care organizations, which bring together hospitals, doctors and other providers in loosely knit organizations that coordinate all levels of care for each enrolled patient.
Mr. Umbdenstock also was able to stop excesses in reform planning. When the administration called for $228 billion from hospitals over 10 years, he spoke out. "This amount is untenable, just unacceptable for hospitals that have been hit by the downturn in the economy," he said. The amount was reduced to $155 billion in Medicaid funding over 10 years in the final law.
Chip Kahn, Federation of American Hospitals
2008 compensation: $2.3 million
In a little over 15 years, Mr. Kahn went from dealing the death blow to President Clinton's healthcare reform proposal to becoming one of the most loyal supporters of Mr. Obama's plan. When he was a lobbyist for the insurance industry, Mr. Kahn helped develop the "Harry and Louise" TV ads against Mr. Clinton's reforms. But in 2007, as leader of FAH, Mr. Kahn released a healthcare reform proposal that could serve as a prototype for the final law. FAH proposals like a universal mandate for health insurance and a Medicaid expansion found their way into the law.
"We are at one of those inflection points in history when healthcare reform is not only possible but desperately needed," Mr. Kahn said during the healthcare debate.
The federation seemingly bet big money by bringing in Mr. Kahn at his multi-million-dollar salary, but in many ways that bet succeeded. By jumping on the reform bandwagon, hospitals avoided a slew of proposals by reform planners. These included a minimum charity-care requirement for tax-exempt hospitals, cuts in indirect medical education subsidies for residency programs and hospital rates set at lower Medicare or Medicaid levels for the new health insurance exchanges. Hospitals also avoided being put under the control of a new rate-setting board for physicians and other providers.
J. James Rohack, American Medical Association
2008 compensation: not applicable
Dr. Rohack, who stepped down from his one-year term as president of the AHA on June 15, made healthcare reform his No. 1 issue and may live to regret it. Although the AMA never fully embraced reform, parsing its position as one of "support," not endorsement, the association was a valuable cheerleader. "While the final product is certainly not what we would have devised," Dr. Rohack said during the debate, "we strongly support the parts of this bill that are desperately needed by millions of Americans who are struggling to get or keep health-insurance coverage."
Dr. Rohack said the legislation lacked a number of pro-physician measures, such as decisive malpractice reforms and removal of the Medicare physician fee cuts. For these reasons, many physicians outright opposed the bill. When AMA's pro-reform stance was challenged by 10 medical societies at an AMA meeting last November in Texas, Dr. Rohack's home turf, the AMA president handily beat back the opposition in a lopsided vote favoring his position.
But the AMA's qualified support netted it only qualified achievements in the final law. Physicians will gain new patients, but many of them will be on Medicaid, which pays below cost. Primary care physicians and general surgeons will see an increase in Medicare pay, but specialists will not. Physicians will see an extension of incentive payments for Medicare quality reporting, but a new Medicare Payment Advisory Board that may unilaterally cut their fees. And Dr. Rohack's hopes of persuading Congress to enact any kind of permanent physician fee-fix seem very dim.
Joseph D. Zuckerman, MD, American Association of Orthopaedic Surgeons
2008 compensation: not applicable
Dr. Zuckerman's one-year term as AAOS president ended a little more than a week before President Obama signed the healthcare reform law. In the reform debate, the AAOS leader was always prefaced his criticisms of the bill by mapping out areas of common interest, such as universal access, insurance reforms and other provisions. That said, the AAOS came out bluntly against the reform bills at a time when the AMA and even the American College of Surgeons generally praised the legislation. Allied with the American Association of Neurological Surgeons, the AAOS organized a widespread uprising that included many surgical specialty groups.
The AAOS/AANS-led coalition declared it was more representative of physicians than the AMA. "America's Physicians DO NOT SUPPORT the current healthcare reform bill," the coalition stated in a release. "Physician organizations representing nearly 500,000 physicians (many more than the AMA) do not support the Patient Protection and Affordable Care Act." The coalition's specific concerns about the bill, however, were little different from the AMA's, covering the too-powerful payment advisory board, lack of meaningful tort reform, the ban on physician-owned hospitals and a continuing failure to pass a permanent fee-fix. One obvious difference was AAOS criticism of the law's extra funding for primary care physicians at the expense of specialists, but that was a topic the AMA, claiming to represent all physicians, was better off ignoring.
It didn't help that President Obama got off on the wrong foot – quite literally – with the orthopedic surgeons. Speaking in favor of preventive care over surgery last August, Mr. Obama said when a diabetic's foot is amputated, the surgeon charges Medicare $30,000-$50,000 and is "immediately" reimbursed. Stunned by the president's inflated idea of what orthopedic surgeons make (and what that might mean for reimbursement adjustments under healthcare reform), the AAOS immediately issued a corrective release. Actually, the release said, this procedure nets only around $700-$1,200 and payment is by no means immediate.
Charles Branch Jr., MD, North American Spine Society
2008 compensation: not applicable
Dr. Branch stepped down as NASS president last November. It's hard to believe that one of his last pronouncements as president, about the need to replace the sustainable growth rate formula causing the physician fee cuts, is still unresolved. "Replacing the SGR formula with a reasonable mechanism for updating Medicare physician fees is the first step toward maintaining appropriate access to specialty care," he said during the debate. An SGR fix was initially part of reform bill but was pulled out of the final version because it drove up the price tag of overall reforms. Lawmakers are still having a very difficult time swallowing the cost of a permanent fee-fix, estimated at $250 billion.
The NASS joined the AAOS coalition against the reform bill and shared many of the AAOS' concerns, such as reduced payments for specialists. "Specialists are continuing to lose more ground in the fees they receive for serving Medicare beneficiaries, while their practice costs steadily rise," Dr. Branch wrote in a letter to House Speaker Nancy Pelosi (D-Calif.) in July 2009. The letter said primary care providers received a pay raise in 2005 while payments for many specialty services were cut in 2008. Dr. Branch's plea didn’t went unheeded. The reform law provides a 10 percent Medicare bonus for many primary care physicians for the next five years and none for specialists.
The NASS had more luck limiting use of proposed comparative effectiveness research (CER). In his letter to Ms. Pelosi, Dr. Branch said NASS supports such research but added, "In no way should findings or recommendations of a CER body be tied to reimbursement decisions." The reform law creates the Patient-Centered Outcomes Research Institute and appropriates $210 million for patient-Centered Outcomes Research Trust Fund, but the law said the institute's findings should not be used to "deny coverage" in federal programs.
Molly Sandvig, Physician Hospitals of America
2008 compensation: $191,000
Next to the drugmakers, health insurers and hospitals, the physician-owned hospitals were small potatoes in the healthcare reform debate, resulting in a provision in the law to ban physician-owned hospitals, added at the behest of the hospitals. The PHA's only significant ally against the provision was the AMA, which was having problems just getting its own wish-list passed.
Nevertheless, Mr. Sandvig and her members were able to convince Congressional Democrats to move the deadline for implementing the ban to Dec. 31 of this year. The original House version would have started the ban retroactively on Feb. 1 and the Senate version originally called for an Aug. 1 deadline, which still left too little time for a hospital in construction to be up and running and get its Medicare certification. Although the Dec. 31 date was a significant coup, many projects still did to night have enough time and the March 23 effective date for a ban on any expansions of existing facilities was not changed.
The PHA filed a lawsuit against the ban in June. "It is truly illogical and unfortunate that at a time the government is supposedly attempting to increase access to care, it has chosen to stop the growth of many of the best hospitals in the country," Ms. Sandvig said in connection with the lawsuit.
Kathy Bryant, Ambulatory Surgery Center Association
2008 compensation: $170,000
In a recent interview on her role in the healthcare reform debate, Ms. Bryant recalled, "We held numerous meetings with the White House, CMS and members of Congress. In those meetings and in other communications with government officials, we made suggestions."
Her chief goal was to convince reform planners to use ASCs as a key strategy to reduce healthcare costs while upholding quality. But one can imagine what the powerful hospital lobby thought of that. Ms. Bryant, who is stepping down this year after 10 years of service, said her efforts were defeated. "Despite all of our hard work, healthcare reform, as enacted, does not in any significant way encourage or expand the federal government’s use of ASCs," she said in the interview.
Nonetheless, Ms. Bryant and other ASC leaders scored a small but important victory. The law changed implementation of a new productivity adjustment for ASCs by one year, thereby averting a lower payment and ensuring a higher base amount for future adjustments. "Essentially, the productivity index will cause payment updates beginning in 2011 and every year after to be lower," she told Becker's ASC Review. "Because of the ASC payment freeze and the method in which our inflation update is already factored, the productivity adjustment will have a disproportionate impact on ASCs."
She added that removing provisions from the reform law is just as important as adding them. "For example, ASC cost reporting was not included in the final legislation and other health sectors, such as home health, have experienced huge reductions that we were largely able to avoid," Ms. Bryant said.
The reform law may end up indirectly harming ASCs. For example, it generally makes healthcare more bureaucratic through structures such as the independent advisory board and could drive down payments by adding more Medicaid recipients. Enhanced federal funding will only temporarily raise Medicaid reimbursements. Meanwhile, ASC physicians will probably continue to have no meaningful professional liability reform or permanent Medicare fee-fix.
Note: 2008 compensation, the latest available, comes from IRS Form 990 filings.