Washington Highlights: May 20, 2005
House Panel Approves
VA Funding Bill
Contents
Prior Issues
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The House Appropriations Committee May 18 approved the FY 2006
Military Quality of Life and Veterans Affairs appropriations bill,
including a 4 percent increase for the Department of Veterans Affairs
(VA) Medical Care appropriation, and a 2.3 percent cut to the VA
research program. Within the total of $28.8 billion provided for
Veterans Health Administration, $21 billion is targeted for VA Medical
Services, an increase of $1.64 billion (8.5 percent). The bill includes
$393 million for VA research, the same level proposed in the President's
budget, and directs the VA to double funding for mental health research.
The bill is scheduled for debate on the House floor during the week
of May 23.
During the full Appropriations Committee mark-up of the bill, Ranking
Member David Obey (D-Wis.) offered an amendment that would have
added $2.6 billion for veterans health care, including a $67 million
increase for the VA research program, funding levels consistent
with the recommendations of the Friends of VA Medical Care and Health
Research Coalition (FOVA). Rep. Obey's amendment would have been
offset by increasing taxes on individuals with incomes over $1 million,
and was defeated by a vote of 27-34. Rep. David Price (D-N.C.) also
spoke during the mark-up in favor of the VA research program, but
did not offer a specific amendment.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
Senators Circulate Sign-On Letter Regarding Residency
Training in Non-Hospital Sites
Senators Susan Collins (R-Maine) and Richard Durbin (D-Ill.) are
circulating a sign-on letter to Centers
for Medicare and Medicaid Services (CMS) Administrator Mark McClellan,
M.D., Ph.D., regarding Medicare reimbursement and regulations related
to resident training in non-hospital sites. The letter specifically
requests that CMS extend the moratorium established by Section 713
of the Medicare Modernization Act (MMA), as well as work with Congress
to resolve the many issues surrounding these regulations.
Concerned with CMS' actions that have resulted in the denial of
payments for the time residents spent in non-hospital
settings where teaching physicians were freely volunteering
their supervisory time, the Senators urge "CMS to act immediately,
through its inherent regulatory authority, to extend and expand
the moratorium" established by Section 713 of the MMA. "Such
action would allow Congress and CMS to further study and work collaboratively
toward a clear and appropriate policy." The Senators are concerned
that Medicare regulations are discouraging "community physicians
in non-hospital settings from agreeing to supervise residents."
In addition to Sens. Collins and Durbin, the following Senators
have signed the letter as of May 19: Evan Bayh (D-Ind.), Jeff Bingaman
(D-N.M.), Christopher Bond (R-Mo.), Barbara Boxer (D-Calif.), Conrad
Burns (R-Mont.), Maria Cantwell (D-Wash.), Hillary Clinton (D-N.Y.),
Norm Coleman (R-Minn.), Kent Conrad (D-N.D.), Jon Corzine (D-N.J.),
Mark Dayton (D-Minn.), Mike DeWine (R-Ohio), Byron Dorgan (D-N.D.),
Russ Feingold (D-Wis.), Dianne Feinstein (D-Calif.), Edward Kennedy
(D-Mass.), John Kerry (D-Mass.), Mary Landrieu (D-La.), Frank Lautenberg
(D-N.J.), Pat Leahy (D-Vt.), Carl Levin (D-Mich.), Patty Murray
(D-Wash.), Ben Nelson (D-Neb.), Barack Obama (D-Ill.), Jack Reed
(D-R.I.), John Rockefeller (D-W.Va.), Pat Roberts (R-Kan.), Rick
Santorum (R-Pa.), Charles Schumer (D-N.Y.), Gordon Smith (R-Ore.),
Debbie Stabenow (D-Mich.), Jim Talent (R-Mo.), George Voinovich
(R-Ohio), and Ron Wyden (D-Ore.).
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Medicare Physician Payment Legislation Introduced
Reps. Clay Shaw (R-Fla.) and Ben Cardin (D-Md.) May 12 introduced
the "Preserving Patient Access to Physicians Act of 2005"
(H.R.
2356), which would avert projected reductions in Medicare physician
payments. Without congressional or administrative action, physicians
are expected to face a 4.3 percent reduction in the conversion factor
in CY 2006. The Medicare Board of Trustees has projected additional
annual reductions through CY 2011.
The bill sets Medicare's CY 2006 physician payment update at "not
less than 2.7 percent." It also replaces the Sustainable Growth
Rate (SGR) methodology with a new formula for calculating physician
payments in CY 2007 and beyond. The new formula, which appears to
be based on recommendations made by the Medicare Payment Advisory
Commission (MedPAC), would reflect changes in input prices, less
a productivity adjustment. MedPAC had recommended the new formula
in its March 2005 Report to Congress as a long-term solution
to the problematic SGR methodology.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
ED Releases Guidance on In-School Consolidation
for FFEL Borrowers
The Department of Education May 16 released a "Dear Colleague"
letter
providing guidance that allows students who borrowed Stafford loans
under the Federal Family Education Loan (FFEL) program to consolidate
their loans while still attending school. Previously, this benefit
had only been available to those students at schools in the Direct
Loan program or that had Direct Loans in their loan portfolio. Currently,
under the FFEL program, borrowers are only allowed to consolidate
Stafford loans that are in repayment. The new guidance allows students
to ask their lenders to put their Stafford loans into repayment
before they are out of school, thereby allowing them to lock-in
current interest rates, which are predicted to increase effective
July 1. Lenders are not required to grant the borrower's request
to have the loans enter repayment early.
Traditionally, Stafford loans enter repayment after a six-month
grace period following the last period the borrower is enrolled
in school. Under the new guidance, a borrower's loans would move
immediately into repayment and the borrower would forfeit the benefit
of the grace period. Since the borrowers in question would still
be enrolled in school, the loans being consolidated may be placed
into an in-school deferment status, and the deferment interest rate
(which is 0.6 percent lower than the repayment rate) would be used
for calculating the weighted average rate for the consolidation
loan.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
NIH to Create "Homes" for Clinical Research in
Academic Institutions
The Advisory Council to the National Institutes of Health's (NIH)
National Center for Research Resources (NCRR) May 19 received a
presentation by Robert Star, M.D., senior advisor on Clinical and
Translational Sciences, and Anthony Hayward, M.D., Ph.D., director
of the Division for Clinical Research, on NIH and NCRR plans to
create integrated programs for clinical research within academic
institutions. Calling modern clinical investigation and translational
research "emerging disciplines," Dr. Star noted that this
research is beset by many challenges, including difficulty in training
and career development, changing infrastructure needs, and the proliferation
of administrative barriers to research. To date, organizational
approaches for the support of research, emphasizing centers and
networks, while making substantial progress, have also created silos
within institutions. Dr. Hayward noted that the new initiative to
transform these silos will be discussed at a
meeting, "Enhancing the Discipline of Clinical and Translational
Sciences" to be held on May 23 in Crystal City, Virginia (near
Washington).
This was the first meeting of the Advisory Council to be chaired
by NCRR's Acting Director, Barbara Alving, M.D. Dr. Alving, the
council, and staff used the opportunity to honor Judy Vaitukaitis,
M.D., who left NCRR as Director in March 2005. "Dr. V."
was a pioneer in reproductive medicine, performing research at NIH
on hormone metabolism in the early 1970s that led to the first practical
home pregnancy test. She later directed the General Clinical Research
Center (GCRC) at Boston University, but returned to NIH in 1986,
and in 1993 became director of the then "Division" of
Research Resources. Under her leadership, the budget of NCRR quadrupled,
and there was important, strategic expansion of the GCRC programs,
animal research centers, facilities construction, and instrumentation,
and also creation of several important programs, including networks
for biomedical imaging and informatics, research networks for orphan
diseases, a program to stimulate competitive research in many states,
and partnerships for secondary education. Dr. Vaitukaitis is currently
a senior advisor on biomedical research infrastructure to NIH Director
Elias Zerhouni, M.D. Dr. Alving announced that a search committee
is being created to seek a new director for NCRR.
Information:
Howard Dickler, M.D.,
hdickler@aamc.org, (202) 828-0567, or
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
New NIEHS Director to Begin
National Institutes of Health (NIH) Director Elias Zerhouni, M.D.,
May 17 announced that David A. Schwartz, M.D., will become the director
of the National Institute of Environmental Health Sciences (NIEHS),
effective May 23. Dr. Schwartz's appointment, which was announced
in October 2004 and originally scheduled for April of this year,
was delayed while his concerns related to the potential difficulty
in recruiting senior advisors under the NIH's interim conflict of
interest rules were appeased. Dr. Schwartz is currently director
of the Pulmonary, Allergy, and Critical Care Division and Vice Chair
of Research in the Department of Medicine at Duke University. He
received his B.A. from the University of Rochester, his M.D. from
the University of California at San Diego, and his M.P.H. from the
Harvard School of Public Health.
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