Washington Highlights: May 13, 2005
CMS Announces Plan
to Review Procedures for Approving Physician-Owned Hospitals, Reform
Medicare Payment Systems; Senate Bill Extending Moratorium Introduced
Contents
Prior Issues
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The Centers for Medicare and Medicaid (CMS) May 12 outlined four
steps it plans to take to correct system problems that may unfairly
advantage physician-owned specialty hospitals. The release of the
CMS recommendations and report coincided with a House Energy and
Commerce Health Subcommittee hearing on physician owned specialty
hospitals and the May 11 introduction of "The Hospital Fair
Competition Act of 2005," by Sens. Charles Grassley (R-Iowa)
and Max Baucus (D-Mont.) extending the current moratorium on niche
hospitals.
Specifically, CMS plans to reform payment rates for inpatient hospital
services through changes to the DRG system; reform payment rates
for ambulatory surgical centers; scrutinize whether facilities meet
the definition of a hospital; and review hospital procedures for
participating in Medicare (i.e., conditions of participation, compliance,
requirements associated with the Emergency Medical Treatment and
Labor Act (EMTALA)).
The CMS
study reviews referral patterns of specialty hospital owners;
compares the quality of care and patient satisfaction with such
care received in these hospitals with local full-service community
hospitals; and assesses both the differences in uncompensated care
between specialty hospitals and local full-service community hospitals
and the relative value of any tax exemption available to community
hospitals. Required by the Medicare Modernization Act, the study,
according to CMS Administrator Mark McClellan, M.D., Ph.D., finds
that specialty hospitals provide "high patient satisfaction,
high quality of care and patient outcomes in some important dimensions,
greater predictability in scheduling and services, and significant
tax contributions to the community."
The release of the CMS recommendations and report coincided with
a House Energy and Commerce Health Subcommittee hearing on physician
owned hospitals. Witnesses included representatives from the Medicare
Payment Advisory Commission (MedPAC), CMS, and the hospital and
physician owned hospital community.
Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) May 11
introduced "The Hospital Fair Competition Act of 2005"
(S. 1002), a bill to permanently extend the moratorium on physician-owned
limited service hospitals set to expire June 8. The bill would not
apply to those limited service hospitals already in operation or
under development before Nov. 18, 2003, but would limit their growth
and investor composition. In addition, the bill adopts the MedPAC's
recommendation to revise DRG payments to inpatient hospital services.
According to a Senate Finance Committee press release, Sen. Grassley
stated that specialty hospitals continue to raise a number of troubling
issues. "Congress needs to take additional steps to address
these issues. Physician-owned specialty hospitals treat the most
profitable patients and services, leaving community hospitals to
treat a disproportionate share of less profitable cases."
Information:Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
AAMC Supports Legislation to Expand Liability
Protections
The AAMC sent a May 10 letter
in support of the "Community Health Center Volunteer Physician
Protection Act of 2005" (H.R.
1313), which would extend liability protections under the Federal
Tort Claims Act (FTCA) to physicians who volunteer their services
at Community Health Centers. The bill was introduced by Rep. Tim
Murphy (R-Pa.), along with Reps. Nancy Johnson (R-Conn.), Sue Kelly
(R-N.Y.), Eric Cantor (R-Va.), Jack Kingston (R-Ga.), Henry Bonilla
(R-Texas), Mary Bono (R-Calif.), Christopher Shays (R-Conn.), Michael
Fitzpatrick (R-Pa.), Michael Burgess (R-Texas), James Walsh (R-N.Y.),
Jeb Bradley (R-N.H.), Randy Neugebauer (R-Texas), Phil Gingrey (R-Ga.),
and John Shadegg (R-Ariz.).
Under H.R. 1313, physicians who volunteer at federally funded health
centers would be deemed Public Health Service (PHS) employees and
thereby qualify for liability coverage under the FTCA. The AAMC
letter applauds H.R. 1313 for providing "a meaningful incentive
for physicians to volunteer their services at Community Health Centers
(CHCs)." The letter states that such action "would help
mitigate the shortage of CHC physicians and thereby improve healthcare
access for many underserved Americans."
In the letter, AAMC President Jordan J. Cohen, M.D., explains that
CHCs "provide unique learning environments and experiences
for many medical students and residents." It praises H.R. 1313
for helping "CHCs maintain these valuable patient care and
medical education activities."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS Releases Final Notice on Payment of 1011 Funds
The Centers for Medicare and Medicaid Services (CMS) May 9 released
its final
policy on section 1011 payments. This notice implements section
1011 of the Medicare Modernization Act (MMA) of 2003, which provides
$250 million per year for fiscal years 2005-2008 for payments to
eligible providers for emergency health services provided to undocumented
aliens and other specified aliens. Payment for services will be
available for services rendered on or after May 10, 2005.
Of the total amount, two-thirds is divided among all 50 states
and the District of Columbia on the basis of their relative percentages
of undocumented aliens. The remaining one-third is divided among
the six states with the largest number of undocumented alien apprehensions--
Arizona, California, Florida, New Mexico, New York, and Texas. Payment
will be made for services provided until the individual is stabilized.
CMS believes that for most patients this will occur within 2 calendar
days.
CMS also is adopting an "indirect patient-based documentation
approach" to determine whether services to an individual are
eligible for payment from these funds. Providers may use a Medicaid
enrollment application or another existing information collection
instrument. If payments exceed the total amount available for a
specified state allotment, there will be a pro rata reduction in
payments. However, in the event that all of the funds allotted to
a state in a fiscal year are not used to pay providers in that state,
the unexpended funds will remain available within that state in
subsequent fiscal years.
This notice has been placed on display at the Office of the Federal
Register and will be published in the Federal Register on or
about May 13, 2005.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Bipartisan Letter Urges IOM Leadership of Medicaid
Commission
Sen. Gordon Smith (R-Ore.) and 11 of his colleagues signed a May
10 bipartisan letter to Health and Human
Services Secretary Mike Leavitt, urging him to charge the Institute
of Medicine (IOM) "with the responsibility to conduct a thorough
review of the Medicaid program." According to the letter, the
Senators "believe that this is the best way to ensure that
the Administration and Congress receive credible, long-range recommendations"
on improving the program's "coverage and access to care, quality,
and cost-effectiveness."
Sent as a follow-up to "discussions … during the Fiscal
Year 2006 Budget Resolution conference," the letter was also
signed by Sens. Susan Collins (R-Maine), Norm Coleman (R-Minn.),
Olympia Snow (R-Maine), Mike DeWine (R-Ohio), Arlen Specter (R-Pa.),
Jeff Bingaman (D-N.M.), Mary Landrieu (D-La.), James Jeffords (I-Vt.),
Richard Durbin (D-Ill.), Daniel Akaka (D-Hawaii), and Lincoln Chaffee
(R-R.I.).
The letter proposes that the IOM submit a report in two stages.
The first would be an "Interim Letter Report," due by
Sept. 1, 2005, that offers recommendations "on how the Congress
can best address the budget resolution conference report recommendations
for reductions in Medicaid spending." The second stage of the
report would be due by Dec. 31, 2006; involve a "more thorough
review of the Medicaid program;" and address the issues that
are outlined by the "Bipartisan Medicaid Commission Act of
2005" (S.
338/H.R.
985).
According to the letter, the IOM's review of Medicaid should incorporate
"broad representation from program stakeholders."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senate VA Research "Dear Colleague" Attracts 44
Signatures
A "Dear Colleague" letter circulated by Sens. Daniel
Akaka (D-Hawaii) and Jim Bunning (R-Ky.) in support of additional
funding for the Department of Veterans Affairs (VA) medical research
program elicited signatures from 42 of their Senate colleagues.
The letter, addressed to Appropriations Subcommittee on Military
Construction and Veterans Affairs Chairman Kay Bailey Hutchison
(R-Texas) and Ranking Member Dianne Feinstein (D-Calif.), states
that "A substantial increase is required to ensure that the
VA research and development program is able to continue addressing
the special needs of our country's veterans." The letter also
notes that the proposed funding level "fails to provide the
resources needed to maintain, upgrade, and replace aging research
facilities."
Signers of the letter include: Sens. Akaka, Max Baucus (D-Mont.),
Jeff Bingaman (D-N.M.), Bunning, Barbara Boxer (D-Calif.), Richard
Burr (R-N.C.), Hillary Clinton (D-N.Y.), Norm Coleman (R-Minn.),
Kent Conrad (D-N.D.), Jon Corzine (D-N.J.), Mike Crapo (R-Idaho),
Elizabeth Dole (R-N.C.), Byron Dorgan (D-N.D.), Richard Durbin (D-Ill.),
Russell Feingold (D-Wis.), Chuck Hagel (R-Neb.), Jim Jeffords (I-Vt.),
Tim Johnson (D-S.D.), Edward Kennedy (D-Mass.), John Kerry (D-Mass.),
Herb Kohl (D-Wis.), Frank Lautenberg (D-N.J.), Pat Leahy (D-Vt.),
Carl Levin (D-Mich.), Blanche Lincoln (D-Ark.), Barbara Mikulski
(D-Md.), Lisa Murkowski (R-Alaska), Patty Murray (D-Wash.), Ben
Nelson (D-Neb.), Bill Nelson (D-Fla.), Barack Obama (D-Ill.), Jack
Reed (D-R.I.), John Rockefeller (D-W.Va.), Ken Salazar (D-Colo.),
Rick Santorum (R-Pa.), Paul Sarbanes (D-Md.), Charles Schumer (D-N.Y.),
Olympia Snowe (R-Maine), Arlen Specter (R-Pa.), Debbie Stabenow
(D-Mich.), Jim Talent (R-Mo.), John Thune (R-S.D.), David Vitter
(R-La.), and Ron Wyden (D-Ore.).
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
National Academies Releases Report on International
Scientists and Engineers
The National Academies May 10 released a report
that calls for a comprehensive effort by the United States to improve
the recruitment, education, and training of the most talented individuals
worldwide in order to maintain leadership in science and engineering
research. The report, "Policy Implications of International
Graduate Students and Postdoctoral Scholars in the United States,"
addresses several recent trends in science and engineering that
affect the ability of the U.S. to maintain a vital science and engineering
enterprise. The National Academies, National Science Foundation,
and National Institutes of Health sponsored the study, which was
chaired by Dr. Phillip Griffiths, Professor of Mathematics at the
Institute for Advanced Study in Princeton, New Jersey.
In recent years, there has been a substantial increase in the proportion
of graduate students and postdoctoral scholars at U.S. institutions
who are not U.S. citizens. Meanwhile, fewer U.S.-born students have
been drawn to science and engineering. The report notes that, for
example, in 1966, 23 percent of people with doctorates in science
and engineering nationwide were foreign-born. In 2000, this number
had grown to 39 percent. In addition, other nations have increased
their efforts to compete for the most talented scientists and engineers
as they recognize the value of science and engineering to their
economies and societies.
In order to address these trends, the committee calls for expanded
research on the policies and programs that would help the United
States attract the brightest international and domestic graduate
students and postdoctoral scholars. The report recommends that universities
continue to offer fellowships and assistantships that encourage
the enrollment of international students. The report also notes
that data on international postdocs are extremely limited. The report
recommends that collecting data on the demographics, working conditions
and career outcomes of postdoctoral scholars should be a priority.
Furthermore, visa and immigration policies should provide clear
procedures that do not unnecessarily hinder the flow of international
graduate students and postdocs. More specifically, the government
should create a new category of visas for foreign postdocs and graduate
students that enable them to be exempt from the requirement to show
that they intend to return to their home countries and make it easier
to collect data on international scholars.
Information:
Jodi Lubetsky, Staff Associate, DBHSR
AAMC Office of Governmenrtal Relations
jlubetsky@aamc.org
(202) 828-0485
National Academies Releases Report on Biomedical
and Behavioral Research Personnel Needs
The National Academies' National Research Council released a report
on the current workforce needs in the biomedical, social and behavioral,
and clinical sciences. The report is the twelfth in a series of
Congressionally mandated reports monitoring the changing needs for
biomedical and behavioral research personnel in the United States.
The purpose of the report, "Advancing the Nation's Health Needs:
NIH Research Training Programs," is to advise the National
Institutes of Health (NIH) and Congress on the appropriate level
of training for the Ruth L. Kirschstein National Research Service
Award (NRSA) Program that supports individual and institutional
training grants at the predoctoral and postdoctoral levels. Gordon
Hammes, Ph.D., University Distinguished Service Professor of Biochemistry
at Duke University, chaired the study panel.
The report highlights the success of the NRSA program and recommends
that the total number of NRSA positions awarded remain at least
at the 2003 level; moreover, future increases should be commensurate
with the rise in the total extramural research funding at NIH in
the biomedical, clinical, and behavioral sciences. To attract physicians
into research, the committee also recommends that the size of the
Medical Scientist Training Programs (MSTP) be expanded by at least
20 percent. In addition, the report suggests that NIH target individual
NRSAs in emerging fields and interdisciplinary areas to encourage
those fields; NIH should also create new oral health and nursing
research programs to attract more trainees.
According to the report, the "time to degree" and age
at which individuals enter the job market as independent investigators
is increasing. Furthermore, the report points out that the current
K award (Career Development Awards) program is overly complex and
discourages applicants. In order to promote career development,
the report makes a number of recommendations to restructure career
development grants and to simplify the current system. Specific
recommendations include: creating a transition award to span senior
postdoctoral status and an independent research position, initiate
beginning faculty awards to free certain classes of investigators
from non-research duties, make senior scientist awards for the purpose
of facilitating faculty moving into new research areas, develop
awards to allow faculty and other researchers to maintain research
careers during periods when personal demands prevent full employment
status, and make clinical science awards to provide research training
for clinical faculty/personnel.
Information:
Jodi Lubetsky, Staff Associate, DBHSR
AAMC Office of Governmenrtal Relations
jlubetsky@aamc.org
(202) 828-0485
Bill Offers Grants, Other Incentives to Support
Health IT Networks
Reps. Tim Murphy (R-Pa.) and Patrick Kennedy (D-R.I.) May 11 introduced
the "21st Century Health Information Act of 2005" (H.R.
2234), which is intended to promote the development and implementation
of regional health information organizations (RHIOs). H.R. 2234
authorizes $50 million in FY 2006 grants to develop and implement
RHIOs, with "such sums as necessary" authorized for FYs
2007 - 2010. No more than 20 grants may be awarded. H.R. 2234 establishes
guidelines for the structure and authority of eligible RHIOs.
RHIOs receiving a grant under H.R. 2234 would qualify for safe-harbors
and exceptions from fraud-and-abuse/anti-kickback laws and regulations.
Moreover, the bill requires the Health and Human Services Secretary
to "consider the establishment" of safe-harbors that "permit
the provision of equipment or services" in support of other
health information technology networks.
The bill also directs the Secretary to "make adjustments"
in Medicare payments for RHIO participants, and to match any Medicaid
funds that are used by states to support the development of RHIOs.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
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