Washington Highlights: April 1,
2005
CY 2006 Physician
Payment Projected to Be -4.3 Percent
Contents
Prior Issues
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The Centers for Medicare and Medicaid Services (CMS) March 31 informed
the Medicare Payment Advisory Commission (MedPAC) that the update
to the 2006 physician fee schedule is currently projected to be
-4.3 percent. A 15 percent growth in expenditures for physician
services occurred in 2004. CMS stated "major contributors to
the rapid increase in spending appear to be certain diagnostic and
therapeutic services, including services particularly important
in the treatment of chronic illnesses." Increases included:
more frequent and more intensive follow-up visits, more frequent
and complex imaging and laboratory tests and minor procedures (such
as physical therapy and chemotherapy administration), and increased
use of drugs in physicians' offices. Medicare Modernization Act
(MMA) provisions, such as the 1.5 percent increase in the 2004 physician
fee schedule update and the floor on the geographic price index,
also contributed to spending growth. It was noted that Medicare
Advantage payments are not included in the physician payment's sustainable
growth rate (SGR) calculations, thus the 8.5 percent payment rate
increase due to MMA provisions and Medicare Advantage enrollment
increases did not contribute to the 2004 spending under the physician
fee schedule.
Finally, CMS expressed support of MedPAC's recommendations for
the development of measures related to the quality and efficiency
of care by individual physicians and groups. CMS intends to continue
to work with the physician community in this arena.
Information:
Mary Patton, Senior Research Associate
AAMC Division of Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Denise Dodero, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
Conyers Reintroduces Resident Hours Legislation
Representative John Conyers, Jr. (D-Mich.) March 10 reintroduced
legislation entitled the "Patient and Physician Safety and
Protection Act of 2005" (H.R.
1228) that would make the regulation of resident work hours
a Medicare hospital condition of participation.
H.R. 1228 would establish specific limits on work hours, allow
residents to file anonymous complaints regarding violations, and
impose financial penalties for noncompliance. Specifically, the
bill limits postgraduate trainees to 80 hours of work per week and
24 hours of work per shift. They must have at least 10 hours between
scheduled shifts, at least one of every 7 days off, and at least
one full weekend off per month. Emergency Department residents may
work no more than 12 continuous hours within the Department. The
bill also limits on-call responsibilities to no more than every
third night.
The bill directs the Secretary of Health and Human Services (HHS)
to promulgate regulations regarding the supervision of residents
and the transfer of patient care responsibilities from resident
to resident. The legislation also directs the Secretary to designate
an individual within HHS to handle resident complaints. That individual
would be authorized to conduct anonymous surveys of residents, conduct
on-site investigations, and provide public disclosure of hospitals
and programs in violation. The bill requires an annual report to
Congress on the compliance of hospitals with such requirements.
H.R. 1228 also offers whistleblower protections to individuals who
report violations to the Secretary, ACGME or hospital management
and subjects hospitals to penalties not to exceed $100,000 for violations
in each resident training program in any 6-month period.
During the last Congress, Rep. Conyers and Sen. Jon Corzine (D-N.J.)
introduced similar resident hours legislation, but no committee
or floor action was taken. The AAMC is opposed to such legislation.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Hospital Price Disclosure Legislation Introduced
Representatives Dan Lipinksi (D-Ill.) and Bob Inglis (R-S.C.) March
17 introduced legislation that would require hospitals and ambulatory
surgery centers to report pricing information on inpatient and outpatient
procedures and administered drugs. Under "The Hospital Price
Disclosure Act" (H.R.
1362), hospitals and ambulatory surgical centers would be required
to report quarterly information electronically to the Secretary
of Health and Human Services (HHS) on the 25 most frequently performed
inpatient and outpatient procedures as well as the 50 most frequently
administered inpatient drugs. Reporting information must include
the frequency of the procedures as well as the average and median
procedure or drug price charged by the hospital or center.
The HHS Secretary would be required to post the reported information
on the Internet and hospitals and centers are required to "prominently"
post a notice indicating the availability of such data.
A press release issued by Rep. Lipinski stated, "As employees
are spending more of their own money on health care services, they
have a right to know how different health care facilities charge
for outpatient procedures." Rep. Lipinski stated that such
information will help consumers make better purchasing decisions.
Rep. Lipinski became concerned about hospital prices after a bicycle
accident last year put him in the hospital.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Department of Commerce Seeks Comments on Deemed
Export Controls
The Bureau of Industry and Security of the U.S. Department of Commerce
(DOC) has released a long-awaited advance notice of proposed rulemaking
on "deemed export controls" [70
Federal Register 15607]. If implemented, the proposed
rules would have wide-ranging and likely profound impacts on many
university activities, including biomedical and biological research
and training.
Under federal regulations, a technology is a "deemed export"
if the technical knowledge is transferred to a foreign national
in the United States. The export of technologies considered important
to national security or which have "dual use" (civilian/military)
applications is extensively controlled by DOC regulations, for example,
by restricting who has access to the technology. Current regulations
do not greatly affect the use of technologies in fundamental university
research where the intent is to publish or otherwise broadly disseminate
such knowledge. But the proposed revised regulations would markedly
alter the control regime, and require universities more thoroughly
to restrict access to controlled technologies (including, for example,
some types of genetically engineered microorganisms, as well as
commonplace equipment). Universities would also face heightened
requirements for managing and reporting on the security of these
technologies. By releasing the advance notice, the DOC hopes to
incorporate academic and other researchers' comments in the formulation
of a final rule.
The Association of American Universities released a summary of
university
concerns with the report.
Information:
Susan Ehringhaus, Sr. Director & Regulatory Counsel
AAMC Biomedical Health Sciences Research
sehringhaus@aamc.org
(202) 828-0543
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
New Leadership at NCRR, CSR
National Institutes of Health (NIH) Director Elias Zerhouni, M.D.,
March 25 announced that Judith Vaitukaitis, M.D., will step down
as Director of the National Center on Research Resources (NCRR)
and assume the position of Senior Advisor on Scientific Infrastructure
and Resources to the NIH Director. Barbara Alving, M.D., Deputy
Director of the National Heart, Lung and Blood Institute (NHLBI)
will serve as Acting Director of NCRR while a search is conducted
for a permanent Director.
Dr. Zerhouni also announced March 21 the appointment of Antonio
Scarpa, M.D., Ph.D., as the new Director of the Center for Scientific
Review (CSR). Dr. Scarpa is currently the David and Inez Myers professor
and chair of the Department of Physiology and Biophysics at Case
Western Reserve University, and a former member of the AAMC Council
of Academic Societies (CAS) Administrative Board.
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