Washington Highlights: March 4,
2005
MedPAC Releases
Report on Medicare Payment Policy
Contents
Prior Issues
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The Medicare Payment Advisory Commission (MedPAC) March 1 released
its March 2005 "Report
to the Congress: Medicare Payment Policy." The report makes
several recommendations for the Medicare program to begin differentiating
among providers when making payments, and recommends updates and
policy improvements to Medicare payment systems. The recommendations
were initially approved at the Commission's January meeting [see
Washington Highlights,
Jan. 14].
Specific recommendations include:
- Medicare should pay more for higher quality performance from
hospitals, home health agencies, and physicians;
- The Centers for Medicare and Medicaid Service (CMS) should include
quality measures that reflect the use and functions of Information
Technology (IT) systems, beginning in physicians' offices;
- Providers who perform imaging studies and physicians who interpret
them should meet quality standards as a condition of Medicare
payment; and
- CMS should measure resource use of physicians serving Medicare
beneficiaries and provide information about practice patterns
confidentially to physicians.
With regard to payment updates and policy improvements, MedPAC
recommended:
- An update equal to a market basket minus 0.4 percent for the
hospital inpatient and outpatient prospective payment systems
and the outpatient dialysis payment system, and an extension of
the hospital outpatient hold harmless provision for small, isolated
rural hospitals;
- An update equal to market basket less an allowance of 0.8 percent
for productivity for the physician fee schedule;
- No update for the skilled nursing facility (SNF) and home health
payment systems.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Health Providers Urge Action on Payment for Resident
Training at Non-Hospital Sites
The AAMC Feb. 18 joined with 29 other healthcare provider organizations
in urging the Centers for Medicare and Medicaid Services (CMS) to
recognize volunteer supervisory physicians at non-hospital sites
for purposes of direct graduate medical education and indirect medical
education payment. The letter,
addressed to CMS Administrator Mark McClellan, M.D., Ph.D., is in
reaction to a Dec. 8 report from the Department of Health and Human
Services Office of Inspector General on alternative payment methods
for the costs of training medical residents in non-hospital settings.
The letter asks Administrator McClellan to "immediately undertake
regulatory actions that acknowledge volunteerism and permit hospitals
and non-hospital sites to determine jointly the amount of supervisory
costs, if any, that must be paid by the hospital."
Specifically, the letter calls on CMS to clarify that where supervising
physicians volunteer as "faculty at a nonhospital site and
the teaching hospital pays the residents' stipends and benefits
and other training costs, if any, as agreed to by the parties, the
hospital has incurred 'all or substantially all' of the costs of
the program and is entitled to count the residents for DGME and
IME purposes." Until the clarification is implemented, the
letter calls on CMS to "extend, through regulatory action,
the moratorium established by Section 713 of the Medicare Modernization
Act (MMA) and expand its coverage to all residency programs regardless
of specialty. While the initial moratorium was mandated legislatively,
we believe strongly that CMS can implement a moratorium on its current
authority." An attachment to the letter supporting this authority
was included.
In addition, the provider groups asked CMS to reaffirm that the
level of payment, if any, should be determined by the parties; policy
initially established by CMS in 1998. The letter states, "In
those cases where the parties agree that supervisory costs exist,
the parties should have the flexibility to decide how this amount
should be determined. If using physicians' salaries is the only
option allowed by CMS, there could be a significant chilling effect
on ambulatory training because many physicians believe their salary
arrangements and determinations are, and should be, a private matter.
Rather than reveal this information as a prerequisite to being a
supervisor some physicians might simply choose not to take on this
important role."
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
AAMC Endorses Bill to Expand Stem Cell Lines
In a March 2 letter to Reps. Mike Castle (R-Del.) and Diana DeGette
(D-Colo.), AAMC President Jordan J. Cohen, M.D. endorsed their legislation
to expand Federal support for stem cell research while adhering
to strict federal oversight and standards. The letter states the
"Stem Cell Research Enhancement Act of 2005" (H.R.
810) "recognizes the need to expand Federal support of
research on pluripotent stem cells so that the tremendous scientific
and medical benefits of their use may one day become available to
the millions of patients who so desperately need them."
The AAMC letter affirms, "The discovery of human pluripotent
stem cells is a significant research advance and Federal support
to American researchers is essential both to translate this discovery
into novel therapies for a range of serious and intractable diseases,
and to ensure that this research is conducted under a rigorous and
credible ethical regime." In accordance with current law, H.R.
810 prohibits Federal funding to derive stem cells or destroy embryos.
The AAMC letter also notes, "We recognize the significant
ethical issues that are raised about embryonic stem cell research
and we respect the view of those who oppose such research, including
some in our own medical school community. However, we are persuaded
otherwise by what we believe is an equally compelling ethical consideration,
namely, that it would be tragic to waste the unique potential afforded
by embryonic stem cells, destined to be discarded in any case, to
alleviate human suffering and enhance the quality of human life."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Dodd Introduces Clinical Trials Data Bank Bill
Senator Christopher Dodd (D-Conn.) introduced legislation Feb.
28 to create a clinical trials data bank for drugs, biological products
and medical devices. The Fair Access to Clinical Trials (FACT) Act
(S.
470) would expand the National Library of Medicine's existing
clinicaltrials.gov registry of clinical trials for drugs and biological
products to treat serious and life-threatening conditions and for
the first time include clinical trials for medical devices. The
registry would include information for "all clinical trials
conducted to test the safety or effectiveness (including comparative
effectiveness) of any drug, biological product, or device (including
those drugs, biological products, or devices approved or cleared
by the Secretary) intended to treat serious or life-threatening
diseases and conditions." Phase I clinical trials conducted
"to test solely the safety of an unapproved drug or unlicensed
biological product, or pilot or feasibility studies conducted to
confirm the design and operating specifications of an unapproved
or not yet cleared medical device" would not be required to
be submitted but could be voluntarily included in the registry.
The bill also would establish a clinical trials results database.
Included in the information to be submitted to the database are
a "summary of the results of the trial in a standard, non-promotional
summary format (such as ICHE3 template form), including the trial
design and methodology, results of the primary and secondary outcome
measures…, [and] summary data tables with respect to the primary
and secondary outcome measures, including information on the statistical
significance or lack thereof of such results." Also required
for submission are safety data "including a summary of all
adverse events specifying the number and type of such events, data
on prespecified adverse events, data on serious adverse events,
and data on overall deaths."
The information to be submitted to the registry and the data bank
"shall be in a format that can be readily accessed and understood
by members of the general public, including patients seeking to
enroll as subjects in clinical trials." Registration of a clinical
trial in registry would be required as a condition for Institutional
Review Board (IRB) approval. In addition, researchers or manufacturers
would be required to submit the results of the trial upon its completion
or face monetary penalties or, in the case of federally funded research,
restriction on future federal funding.
Senators Charles Grassley (R-Iowa), Tim Johnson (D-S.D.), and Ron
Wyden (D-Ore.) are original co-sponsors of the bill.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
GAO Announces Citizen's Health Care Working Group
Comptroller General of the United States David Walker Feb. 28 announced
the appointment of 14 members to the Citizen's Health Care Working
Group. The Working Group was created by Congress to hold hearings
and community meetings across the country on health care coverage
and cost issues, and to issue a "Health Report to the American
People" within two years. Mr. Walker, who heads the Government
Accountability Office (GAO), selected Randall Johnson, director
of Human Resources Strategic Initiatives for Motorola, as the chairman
of the Working Group. Catherine McLaughlin, Ph.D., professor in
the Department of Health Management and Policy at the University
of Michigan will serve as vice-chair. Other members of the Working
Group include:
- Frank Baumeister, Jr., M.D., past president of the Oregon
Medical Association and past chairman of the Oregon Health Resources
Commission;
- Dorothy Bazos, R.N., Ph.D., health policy consultant and
adjunct professor at Dartmouth College;
- Montye Conlan, advocate for the diabled;
- Richard Frank, Ph.D., professor of health economics at Harvard
Medical School;
- Joseph Hansen, president of the United Food and Commercial
Workers International Union;
- Therese Hughes, government relations and legislative analyst
at the Venice Family Clinic;
- Brent James, M.D., vice president of Intermountain Health
Care and clinical professor at the University of Utah Medical
School;
- Patricia Maryland, president of St. Vincent Hospitals and
Health Services, Inc.;
- Rosario Perez, R.N., director of community outreach at CHRISTUS
St. Joseph Hospital;
- Aaron Shirley, M.D., associate professor in pediatrics at
the University of Mississippi Medical Center;
- Deborah Stehr, health care advocate; and
- Christine Wright, R.N., director of Cancer Services and Radiation
Oncology at Sioux Valley Hospital USD Medical Center.
Senate Appropriations Committee Announces Reorganization
Senate Appropriations Committee Chairman Thad Cochran (R-Miss.)
March 2 announced a reorganization of the committee's subcommittee
structure. The reorganization is similar, but not identical, to
the reorganization of the House Appropriations Committee announced
last month [see Washington
Highlights, Feb. 18]. Under the new Senate plan, the VA-HUD subcommittee
would be eliminated, with jurisdiction over the Department of Veterans
Affairs moving to join the Military Construction subcommittee, which
will be chaired by Sen. Kay Bailey Hutchison (R-Texas). The National
Science Foundation would be shifted to the Commerce, Justice and
Science Subcommittee, chaired by Sen. Richard Shelby (R-Ala.). The
Labor-HHS-Education Subcommittee remains intact with the addition
of the Corporation for National and Community Service from the former
VA-HUD Subcommittee.
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