Washington Highlights: October
8, 2004
Senate Approves VA Pay Bill
Contents
Prior Issues
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The Senate Oct. 5 approved by unanimous consent S.
2484, the "Department of Veterans Affairs Health Care Personnel
Enhancement Act of 2004," also known as the VA Physician Pay
Bill. The version passed by the Senate includes new provisions negotiated
with veterans and physician groups and through discussions with
the House Veterans' Affairs Committee. The AAMC Oct. 6 sent a letter
to House Veterans' Affairs Committee Chairman Chris Smith (R-N.J.)
urging him to support swift passage of the legislation.
Specifically, the Senate-passed version includes three major components:
base pay, market pay, and performance pay. Base pay would be set
according to the VA physician's longevity in the VA health care
system and would include automatic pay ncreases every two years.
Market pay would be based on specialty and assignment, with "pay
bands" determined by the Secretary of Veterans Affairs based
on consultation with at least two national surveys every two years.
The Secretary's findings from these surveys would be published in
the Federal Register and open for public comment. An individual
physician's total pay would be determined by an "appropriate
panel or board composed of physicians" at the local facility.
The performance pay portion of the proposed system would allow for
individuals to receive up to the lesser of $15,000 or 7.5 percent
of the physician's salary for meeting specific goals or performance
objectives as set by the Secretary. An individual physician's total
pay could not be decreased unless a specialty or assignment changed;
however, there would be an appeals process for involuntary changes.
The new system would take effect on Jan. 1, 2006; in the interim,
all pay will be determined as if the current system was continued.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
GAO Assesses Impact of Privacy Rule's First Year
The Government Accountability Office (GAO) Oct. 4 released a report
summarizing the experiences of providers and health organizations
during the first year of implementing the federal rule governing
health information privacy. Issued under the Health Insurance Portability
and Accountability Act of 1996 (HIPAA) [PL
104-191], the privacy rule provided new protections regarding
the confidentiality of health information and established new responsibilities
for providers, health plans, and other entities to protect such
information. In addition to the experience of providers and health
plans, the report also documents the difficulties of public health
entities, researchers, and representatives of patients in obtaining
access to health information under the rule, and the extent to which
patients appear to be aware of their rights.
Organizations representing providers and health plans reported
that implementation of the privacy rule went more smoothly than
expected during the first year most entities were required to be
compliant. However, provider and health plan representatives also
raised a variety of issues about provisions that continue to be
problematic. In particular, many organizations emphasized that two
provisions - the requirement to account for certain information
disclosures and the requirement to develop agreements with business
associates that extend privacy protections "downstream"
- are unnecessarily burdensome. Some organizations suggested that
difficulties with these provisions could be ameliorated with modification
of certain provisions and further guidance from the Department of
Health and Human Services' (HHS) Office for Civil Rights (OCR),
the agency responsible for enforcing the privacy rule.
The report also outlines a number of challenges faced by entities
that rely on access to health information for public health monitoring,
research, and patient advocacy. Public health entities noted that
some states have had to take concerted action to ensure that providers'
concerns about complying with the privacy rule do not impede the
flow of important information to state health departments and disease
registries. Some research groups asserted that the rule has delayed
clinical and health services research by reducing access to data.
Some consumer advocacy groups reported that patients' families,
friends, and other representatives have experienced unnecessary
difficulty in assisting patients. These groups perceived that while
providers and plans are allowed, in certain cases, to disclose health
information without written patient authorization, they are reluctant
to do so.
GAO recommends that HHS require that patients be informed of mandatory
disclosures to public health authorities in privacy notices and
exempt such disclosures from the accounting requirement, and conduct
a public information campaign to improve patients' awareness of
their rights. GAO also remains concerned about the burden of accounting
for disclosures to public health authorities and believes it is
important that HHS more effectively disseminate information about
the privacy rule.
In preparing the report, which was requested by the Senate Health,
Education, Labor and Pensions (HELP) Committee, GAO interviewed
representatives of 23 national organizations representing health
care consumers, health care providers, health plans, state officials,
public health agencies, researchers, and privacy professionals,
including the AAMC, the American Hospital Association, the American
Medical Association and the Joint Commission on Accreditation of
Healthcare Organizations.
Information:
Susan Ehringhaus, Sr. Director & Regulatory Counsel
AAMC Biomedical Health Sciences Research
sehringhaus@aamc.org
(202) 828-0543
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
AAMC and FASEB Issue Second Letter on HHS "WHO"
Policy
AAMC President Jordan Cohen, M.D., and Paul Kincade, Ph.D., President
of the Federation of American Societies for Experimental Biology
(FASEB), Oct. 6 restated their organizations' objection to a policy
that requires central clearance for HHS-employed scientists invited
to international meetings. "[W]hen government scientists are
invited to participate in international forums not as official representatives
or spokespersons of the United States government, but rather solely
as scientists on the basis of their expertise, contributions and
international stature, those invitations should not be mediated
through the Office of the Secretary at all." The statement
was made in a letter replying to William Steiger, Ph.D., special
assistant for international affairs to Health and Human Services
(HHS) Secretary Tommy Thompson.
Earlier, Dr. Steiger had responded to the first AAMC-FASEB letter
on this issue [see Washington
Highlights, July 23],
which revolves around NIH and CDC scientists invited to serve as
"technical consultants" participating in meetings of the
World Health Organization (WHO). Dr. Steiger noted that the HHS
policy was intended to ensure that appropriately qualified experts
from the Department's considerable pool of scientific talent were
selected for these assignments. Dr. Steiger also believes that the
policy would provide for transparency and better accountability
within the Department, and he specifically contrasted the policy
with any process that would seek to "politicize" the appointment
of scientific experts. But the AAMC and FASEB disagree, arguing
that judging the requisite scientific qualifications of invitees
is best done by the forum's sponsors, and an employee's availability
for assignment is best assessed by their supervisors. In such circumstances,
Drs. Cohen and Kincade state, "the newly articulated interposition
of the Office of the Secretary…only raises fears of political
litmus tests that we would deplore."
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
House Approves One-Year "Clean" Reauthorization
of HEA
The House of Representatives Oct. 6 approved by voice vote a "clean"
one-year extension of programs authorized under the Higher Education
Act (HEA). The legislation, H.R.
5185, makes no policy changes, and allows uninterrupted administration
of the programs through FY 2005 while the Congress continues to
debate a longer reauthorization. The House Oct. 7 also approved
by a vote of 414-0 legislation (H.R.
5186) to close for one year a loophole in lending rules that
allows lenders to collect a significant profit on certain types
of loans. The savings associated with closing the loophole would
be used to increase loan forgiveness for elementary and secondary
school teachers of math, science and special education.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
CMS Changes Stance on 1011 Funds
Centers for Medicare and Medicaid Services (CMS) Administrator
Mark McClellan, M.D., Ph.D., issued an Oct. 1 letter stating "providers
will not be asked - and should not ask - about a patient's citizenship
status in order to receive payment" under Section 1011 of the
Medicare Modernization Act (MMA), which provides $250 million per
year for fiscal years 2005-08 to reimburse eligible providers for
emergency health services for emergency care for undocumented aliens.
In its proposed methodology for distribution of these funds, the
CMS required providers to ask about a patient's citizenship status.
The AAMC and many other organizations objected to this requirement,
as it would likely discourage undocumented aliens from seeking needed
care. Due to this change, a previously published data collection
instrument that was to be used by all providers seeking Section
1011 funds will not be part of the final policy.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
Legislation Proposes Federal Regulation of Hospital
Group Purchasing Industry
Legislation introduced Oct. 1 would give the Department of Health
and Human Services (HHS) oversight authority over hospital group
purchasing organizations. "The Medical Device Competition Act,
S.
2880, introduced by Sens. Herb Kohl (D-Wisc.) and Mike DeWine
(R-Ohio) would, according to Sen. Kohl's introductory statement,
direct HHS to draft regulations to prevent hospital group purchasing
organizations from "unethical conduct, anti-competitive practices,
or practices which preclude products necessary for patient care
or worker safety from reaching physicians and patients."
The introduction of the legislation is a follow up to a hearing
held Sept. 14 by the Senate Judiciary Antitrust Subcommittee where
representatives from the group purchasing industry and medical device
companies testified.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
House Approves 2-Year Extension of J-1 Visa Waiver
Program
The House of Representatives Oct. 6 approved legislation (H.R.
4453) extending for two years the J-1 Visa Waiver Program, which
provides each state with authority to sponsor waivers permitting
foreign physicians who complete their residency training in this
country to avoid the two-year home country requirement associated
with the J-1 visa program. In return, the foreign physicians are
required to provide health care in underserved areas for a minimum
of three years. An amendment offered in the House Judiciary Committee
would allow up to five physicians in each state to work in areas
that are not designated as underserved. Additionally, the bill,
as approved, would clarify that physicians that transfer into the
H-1B visa program do not count against the statutory cap on H-1B
visas. The program expired on May 31.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
House-Passed Bill Would Create Drug Monitoring
Program
The House Oct. 5 passed by voice vote legislation that would establish
an electronic prescription drug monitoring program. The "National
All Schedules Prescription Electronic Reporting Act of 2004"
(NASPER) (H.R.
3015) would create a database to help states, providers, and
other entities compile the information needed to identify the abuse
or diversion of Schedule II, III, or IV controlled substances. NASPER
was introduced by Rep. Ed Whitfield (R-Ky.) and incorporates amendments
by Reps. Charles Norwood (R-Ga.) and Frank Pallone (D-N.J.). The
amendments were intended to assure that HIPAA privacy provisions
applied to the collected data.
According to statements made during the floor debate, 21 states
already have such monitoring programs in place, including Rep. Whitfield's
home state of Kentucky. Rep. Bart Stupak (D-Mich.) stated that a
2002 report from the General Accounting Office (GAO) concluded the
programs "are useful tools" in preventing the abuse of
prescription drugs. Speaking in opposition to the bill, Rep. Ron
Paul (R-Texas) expressed concern that the program would discourage
physicians from prescribing "an adequate amount of pain medication,
or even any pain medication, for their suffering patients."
Rep. Paul also argued that NASPER threatened patient privacy by
increasing government access to patient records.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
House Calls for Study of NIH Roadmap
A report on the NIH Roadmap's activities related to spinal cord
injury and paralysis is one of four studies mandated by the "Research
Review Act of 2004" (H.R.
5213), which the House passed Oct. 7 under a suspension of the
rules. The bill calls for the Secretary of Health and Human Services,
in coordination with the NIH Director, to prepare a report outlining
the methods by which the NIH Roadmap "has advanced the use
of multidisciplinary research teams and consortia of research institutions
to advance treatments, develop new therapies, and collaborate on
clinical trials, including with respect to spinal cord injury and
paralysis research." The report is due to Congress by Feb.
1, 2005.
The bill also calls for three studies related to inflammatory bowel
disease. The bill directs the Secretary, acting through the Director
of the Centers for Disease Control and Prevention (CDC), to prepare
a report "outlining the epidemiological studies currently underway
at [CDC], future planned studies, the criteria involved in determining
what epidemiological studies to conduct, defer, or suspend, and
the scope of those studies, including with respect to the inflammatory
bowel disease epidemiological study." The Government Accountability
Office (GAO) is asked to study the coverage standards under Medicare
and Medicaid, respectively, that apply to patients with inflammatory
bowel disease undergoing various therapies. The bill also directs
GAO to study the problems patients encounter when applying for disability
insurance benefits under Social Security, including recommendations
for improving the application process for patients with inflammatory
bowel disease.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
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