Washington Highlights: Date
Washington Highlights
Contents
Prior Issues
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Senate Committee Critical of Bioterrorism Programs
The Senate Health, Education, Labor and Pensions Committee held
a July 22 hearing
to examine the bioterrorism preparedness programs administered by
the Department of Health and Human Services (HHS). Chairman Judd
Gregg (R-N.H.) criticized the Health Resources and Services Administration
(HRSA) hospital bioterrorism preparedness program and the Centers
for Disease Control and Prevention (CDC) state bioterrorism preparedness
program for not getting funding to the facilities that make up the
front line of defense against a potential attack. He supports funding
awarded to regions, using a threat-based formula. Ranking Member
Edward Kennedy (D-Mass.) echoed these concerns, noting that the
Boston Medical Center has spent $2.7 million on bioterrorism preparedness,
but only received $37,000 from HRSA.
HHS Secretary Tommy Thompson explained that the states are awarded
the funds and determine which hospitals receive money. He agreed
with the panel that HHS should have more authority over how the
money is spent and be able to override state plans. George Thibault,
M.D., vice president of clinical affairs for Partners HealthCare,
representing the Conference of Boston Teaching Hospitals, testified
that academic health centers' ability to prepare for a bioterrorist
event is dependent on aving adequate financial resources to maintain
their fundamental responsibilities of training physicians, conducting
research, and implementing new medical treatments.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Office of Governmental Relations
efroyd@aamc.org
(202) 828-0525
CMS Proposes Policy to Implement MMA Provisions
on Care for Undocumented Immigrants
The Centers for Medicare and Medicaid Services (CMS) July 22 released
a proposed
payment methodology (PDF) to implement a requirement in Section 1011
of the Medicare Modernization Act (MMA), which requires the agency
to reimburse hospitals, physicians and ambulance services directly
for emergency services provided to undocumented immigrants. Section
1011 of the MMA provides $250 million a year for FYs 2005 - 2008
to help providers defray the cost of meeting federal requirements
under the Emergency Medical Treatment and Labor Act (EMTALA) to
provide care to stabilize patients regardless of insurance status
or ability to pay. In each year, two-thirds of the $250 million,
or $167 million, will be allocated proportionately among the 50
states and the District of Columbia. The remaining $83 million will
be distributed among the six states with the highest number of undocumented
alien apprehensions for each fiscal year. CMS' preliminary analysis
using FY 2003 data indicates that these six states are: Arizona,
California, Florida, New Mexico, New York and Texas. These states
could change pending final analysis of data from FY 2004.
CMS proposes that each provider within a state would receive a
payment equal to the Medicare reimbursement rate or, if the provider
payments exceed the state allotment, providers would receive a proportional
payment of the Medicare reimbursement rate. Payment would be made
for all emergency services and would end when a patient is discharged
from the hospital. Hospitals and other eligible providers would
be required to query patients directly about immigration status
and maintain that information. Requests for payment from the fund
would be submitted only after payment had been sought from all available
funding sources, state or local government (e.g., Medicaid), private
insurers or health maintenance organizations, or direct payments
from a patient.
CMS is not planning to publish a Notice of Proposed Rulemaking
(NPRM), but will need to publish a Paperwork Reduction Act (PRA)
notice in the Federal Register. Because of the statutory
date for implementing this provision (Sept. 1, 2004), CMS will use
the emergency PRA notice and clearance process and have an abbreviated
comment period. CMS will hold an "open door" meeting on
August 2 by phone and in person; instructions are available in the
proposal document. Additionally, written comments on the proposal
may be submitted by August 16.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
New GAO Report Addresses VA Part-Time Physicians
Time and Attendance Documentation
The Government Accountability Office (GAO) July 21 released a new
report, "VA
Medical Centers: Internal Controls Over Selected Operating Functions
Needs Improvement" that concludes that Department of Veterans
Affairs (VA) part-time physician time and attendance were not always
documented according to policy. The report's authors visited six
VA medical centers and studied ten part-time physicians at each
location over two pay periods ending in September 2003. The report
also addresses property control databases and the process used for
obtaining credit for recalled, expired or deteriorated drugs.
The Veterans Health Administration (VHA) issued a directive
in January 2003 (VHA Directive 2003-001) that requires individual
medical centers to monitor compliance with part-time physician time
and attendance policy; however, the GAO found that "the latitude
provided in the directive resulted in wide variation in procedures
used by the six medical centers to verify physician compliance with
work schedules." The new GAO report notes that "[S]ome
of the methodologies adopted were less effective than others,"
and concludes that "[C]urrent policies and procedures for monitoring
part-time physician time and attendance, if implemented more effectively,
may provide reasonable assurance that management's objectives will
be met." The report recommends that "the Secretary of
Veterans Affairs direct the Assistant Secretary for Management to
coordinate all time and attendance system changes within VHA, in
order to ensure that the time and attendance system facilitates
entry of actual hours and days worked by part-time physicians into
VA's permanent electronic time and attendance record." Further,
the Under Secretary for Health should "conduct a best practices
review of procedures implemented by VA medical centers and service
areas to identify those most effective in documenting daily attendance
of part-time physicians and periodically monitoring employee compliance
with time and attendance requirements; and use the results of the
best practices review to provide more definitive policy guidance
to improve control effectiveness over part-time physician attendance
monitoring."
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Office of Governmental Relations
jfishburn@aamc.org
(202) 828-0525
House Panel Explores Barriers, Incentives for
Adoption of Health Information Technology
Health information technology (HIT) was the topic of a July 22
hearing
held by the House Energy and Commerce Subcommittee on Health. According
to a statement by full Committee Chairman Joe Barton (R-Texas),
a transition to electronic medical records could save about $140
billion a year. Calling the potential savings "staggering"
and arguing that electronic records "could go a long way toward
slowing the tremendous growth in healthcare costs," Chairman
Barton remarked that "patients should not have to bear the
increased risk of medical errors and pay the inflated costs that
result from the use of antiquated health information systems."
He added that "[o]ther sectors of our economy have adopted
the widespread use of electronic forms and records," and inquired
"why hasn't the majority of the healthcare sector caught up?"
Subcommittee Chairman Michael Bilirakis (R-Fla.) criticized the
healthcare industry for "dragging its feet in this area and
… progressing much slower than other sectors of the economy."
Chairman Bilirakis hoped the hearing would help identify "the
barriers that have slowed the adoption of this technology by hospitals,
doctors, and other health care providers."
Department of Health and Human Services (HHS) Secretary Tommy Thompson
used the hearing to outline the Administration's new framework
for developing a national HIT infrastructure. According to Secretary
Thompson, the framework "will guide discussion, investigation
and experimentation to accelerate widespread adoption of HIT in
both the public and private sectors." Secretary Thompson identified
a lack of cohesive policies and a perceived lack of return on investment
as the greatest barriers to the Administration's vision.
The first step in laying out the framework will include the creation
of a Health Information Technology Leadership Panel. According to
Secretary Thompson, the members will review the costs and benefits
of HIT to industry and individuals. The panel will then develop
and present "options for immediate steps by both the public
and private sector" by the fall. To increase the use of HIT,
the Administration's framework will work with the private sector
to establish certification standards for HIT products "based
on functionality, security, and interoperability."
Secretary Thompson also anticipates the availability of $2.3 million
in community HIT demonstration grants to serve as "seed funds"
to support "multi-stakeholder collaborations within communities…
to implement health information exchanges" and "drive
improvements in health care quality, safety, and efficiency."
The Secretary added that the Centers for Medicare and Medicaid Services
(CMS) plans to propose a regulation to adopt widely used e-prescribing
standards. "When the final standards are adopted," Secretary
Thompson advised, "Medicare Prescription Drug Plan (PDP) sponsors
will be required to support e-prescribing, which will significantly
drive adoption across the United States."
Also testifying at the hearing was Edward Shortliffe, M.D., Ph.D.,
director of Medical Information Services at New York Presbyterian
Hospital, who warned the Subcommittee that their "view of what
is needed" should not be "overly skewed by the perspectives
of those who practice in large, multi-specialty practices or in
clinics associated with academic medical centers." According
to Dr. Shortliffe, "the vast majority of healthcare in this
country is provided by physicians in … relatively small offices."
Dr. Shortliffe also advised that, for many providers, HIT "is
not their area of expertise, and they are uncertain how to evaluate
the options that are provided to them." He added that HIT "is
not a part of their education," and that it is "often
disruptive to office operations," with physicians discovering
that their "major investments have resulted in inadequate systems
[and] solutions that fail to meet expectations, integrate poorly
with other systems, or are difficult to adapt to the special needs
of a particular practice." During his testimony, Dr. Shortliffe
also reported that "arguments for implementation of HIT are
too often viewed by clinicians as being primarily directed at health
systems, payers, and patients, with much less direct benefit appreciated
by the physicians themselves."
Subsequently, Dr. Shortliffe argued for the "alignment of
financial incentives so that those who most benefit from the investment
HIT are the ones who are expected to invest most heavily in its
dissemination and implementation." He also urged "federally
facilitated programs to enhance the process for setting and adopting
standards" and "a mechanism for assuring rigorous certification
of vendor-provided solutions." Finally, Dr. Shortliffe proposed
initiatives to "nurture the training of experts who can be
the researchers, designers, developers, implementers, and evaluators
of HIT in the future."
Similarly, David Bumenthal, M.D., M.P.P., director of Massachusetts
General Hospital's Institute for Health Policy, testified that HIT
"has the power to save as many or more lives than antibiotics,"
yet remains "unused, and will not be employed to their full
potential unless we act collectively to assure this will happen."
Dr. Blumenthal argued for public-private partnerships to develop
interoperability standards, financial support and/or incentives,
seamless regional information networks, and the relaxation of regulations
that inhibit provider collaboration in the development of HIT systems.
Dr. Blumenthal advised that any financial assistance should target
small physician groups and rural hospitals, as well as institutions
that serve a large number of indigent patients.
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Health Information Technology Bills Introduced
in House and Senate
New legislation has been introduced in both chambers of Congress
to provide guidance and resources for implementing health information
technology through a combination of grants, loans, and payment incentives
to promote adoption of information technologies In the Senate, Judd
Gregg's (R-N.H.) "National Health Information Technology Adoption
Act" (S.
2710) would help hospitals, physician groups, and other providers
fund "Local Health Information Infrastructures" similar
to the regionally linked systems in Indianapolis and Santa Barbara.
Among the provisions in S. 2710 are new loan guarantees, as well
as $50 million in annual matching grants (FY 2005 - FY 2010) for
entities that "demonstrate financial need" and provide
services to low income and underserved populations. Under the matching
grants, the federal government would provide five dollars for every
one dollar invested by the grant recipient.
On the House side, Representative Patrick Kennedy's (D-R.I.) legislation,
the "Josie King Act of 2004" (H.R. 4880), establishes
nearly $3 billion in various grants for the development, implementation,
and expansion of regional "health information exchanges."
In some cases, the grants will be allocated according to provider
participation rates in a particular state or region. Rep. Kennedy's
bill also creates a "clearinghouse" of implementation
strategies and best-practices, from which other providers can gain
insight and information as they adopt health information technology.
Additionally, H.R. 4880 mandates the certification and interoperability
of health information technologies to help assure that providers
invest in compatible infrastructures. H.R. 4880 would also allow
the Secretary to establish a limited, temporary (six-year) Medicare
"pay for performance" component in the Medicare program.
After six years, MedPAC would review the data and make recommendations
regarding broad implementation of performance-based Medicare payments.
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
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