Washington Highlights: July 1, 2005
Contents
Prior Issues
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Senate, House Differ on VA Medical Care Funding
Solution
Following an announcement from the Department of Veterans Affairs
(VA) that the agency was $1 billion short of funding for veterans
health care in FY 2005, both the Senate and the House June 29 moved
to add more funding but disagreed on the amount. The Senate added
$1.5 billion for the VA to its version the FY 2006 Interior Appropriations
bill. The House, meanwhile, agreed to an Administration request
calling for a $975 million supplemental appropriation, a proposal
the Senate Appropriations Committee promptly rejected as too low.
The VA announced the shortfall at a June 23 hearing in the House
Veterans Affairs Committee, based on the results of a mid-year financial
review. The shortfall is the result of inaccurate actuarial models
that underestimated the number of new patients at the VA and the
number of veterans returning from Iraq and Afghanistan. VA planned
to address the shortfall by diverting $600 million previously budgeted
for capital infrastructure, and $400 million that was intended to
be carried over to FY 2006.
VA Secretary Jim Nicholson faced harsh criticism June 28 in front
of two separate congressional committees, answering questions about
when VA identified the shortfall and how it was being addressed.
In front of the House Military Quality of Life Appropriations Subcommittee
and the Senate Veterans Affairs Committee, Secretary Nicholson acknowledged
that VA has seen an increase in demand for VA health care services
from "enrolled veterans in all priority levels and from all
combat eras." He also noted that the actuarial model assumed
a total of 23,553 VA patients from the Iraq and Afghanistan conflicts,
while the actual number is estimated at 103,000. Secretary Nicholson
indicated that the Department also would need $1.5 billion in new
resources for FY 2006, plus the enactment of policies in the President's
budget proposal calling for enrollment fees and increased co-payments.
Without enactment of such policies, which Congress has previously
rejected, the increase needed for FY 2006 would be approximately
$2.7 billion.
Secretary Nicholson also faced intense questioning at a third hearing
held June 30 in the House Veterans Affairs committee. Representative
Bob Filner (D-Calif.) went as far as to recommend Secretary Nicholson's
resignation. VA Under Secretary for Health, Jonathan B. Perlin,
M.D., Ph.D., described a contract with Duke University to develop
a new actuary model to avoid future budgetary inaccuracies. During
that hearing, Secretary Nicholson outlined a $975 million supplemental
budget request from the White House for FY 2005 that the House passed
later in the day by a vote of 419-0. However, the Senate Appropriations
Committee immediately rejected this proposal by passing a motion
by voice vote that it would accept nothing less than $1.5 billion.
One option reportedly under discussion by Republicans and Democrats
would call for the Administration to submit another VA funding request
after the July 4th recess to supplement its FY 2005 request. The
Senate would then call up the House bill, amend it with the additional
funds and return it to the House.
The supplemental approved by the House includes:
- $273 million to fund healthcare for returning Operation Iraqi
Freedom and Operation Enduring Freedom veterans, including members
of the Guard and Reserve;
- $226 million to continue funding the shared federal and state
VA long-term care nursing home program;
- $200 million to fund unanticipated increases in the healthcare
for priority-group 1-6 veterans;
- $95 million to fund unanticipated energy, fuel and utility
costs;
- $84 million to buy emergency medical equipment; and
- $39 million to pay for the increase in healthcare benefits
for dependants of 100-percent service-connected veterans as the
need has increased at a rate greater than expected.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
CMS Letter Reviews Its Value-Based Purchasing
Activities
A June 24 letter from the Centers for Medicare & Medicaid Services
(CMS) Administrator Mark McClellan, M.D., Ph.D to House Ways and
Means Committee Chairman Bill Thomas (R-Calif.) and Health Subcommittee
Chair Nancy Johnson (R-Conn.) summarizes a range of activities in
which CMS has participated to move Medicare more towards "value-based
purchasing." The letter discusses CMS' involvement in the development
of quality indicators and systems for reporting and analyzing quality
indicators, as well as its experience with a number of CMS programs
that tie quality measures to Medicare payment. The letter is in
response to a June 16 letter from Reps. Thomas and Johnson requesting
that CMS document their experience.
Stating that "linking a portion of Medicare payments to valid
measures of quality and effective use of resources would give providers
more direct incentives and financial support to implement the innovative
ideas and approaches that actually result in improvements in the
value of care that our beneficiaries receive," much of the
letter and its enclosures summarize CMS' work with hospitals, skilled
nursing facilities, home health agencies, end stage renal disease
facilities and physicians in developing quality indicators.
The letter references CMS' collaboration with the Hospital Quality
Alliance, a national public-private partnership that includes the
AAMC, in encouraging hospitals to collect and report voluntarily
a set of 10 measures related to hospital quality performance. "We
expect to expand these (hospital) measures further in the coming
year to include standardized measures of quality from the beneficiary's
perspective and outcome measures, such as those related to post-surgical
complications."
In discussing its collaborations with the physician community,
the letter states that such processes "have already resulted
in clinically valid quality measures for many physician specialties,
some specialty societies report that they are still in the development
stage, and a few are not reporting any activity…. A preliminary
assessment indicates that the specialties for which some measures
have been developed account for about half of Medicare physician
spending. Specialties accounting for another 40 percent of physician
spending have measures under development." CMS also is looking
at ways to measure resource use of physicians, including the use
of claims data to review physician patterns of practice. Such information
and results could be shared with physicians "confidentially
to educate them about how they compare to peers."
The letter was released the same week that Senate Finance Committee
Chairman Charles Grassley (R-Iowa) and Ranking Minority Member Max
Baucus (D-Mont.) are expected to introduce legislation linking Medicare
payments to performance for hospitals, physicians, skilled nursing
facilities, end-stage renal dialysis facilities, home health agencies,
and managed care plans.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Senators, Members of Congress Circulate Post-Acute
Transfer Letter
Senators Craig Thomas (R-Wyo.) and Kent Conrad (D-N.D.) and Reps.
Jim Nussle (R-Iowa) and Earl Pomeroy (D-N.D.) are circulating for
signatures a "Dear Colleague" letter
urging Centers for Medicare & Medicaid Services (CMS) Administrator
Mark McClellan, M.D., Ph.D., "not to implement and further
broaden the post-acute transfer provision."
The FY 2005 Proposed
Rule for the Medicare Inpatient Prospective Payment System would
expand the post-acute care transfer policy from 30 to 223 Diagnostic
Related Groups (DRG)s in FFY 2006. According to CMS, this proposal
would result in $880 million less in Medicare program payments to
hospitals, the equivalent of a 1.1 percent decrease in payments.
According to the Senate and House letter, "this proposed expansion
of a misguided policy undermines the basic principles and objectives
of the inpatient hospital prospective payment system…. The
proposal significantly expands hospitals' liability for decisions
not within their control" because "patients and their
physicians typically order and arrange post-acute care, often without
the knowledge of the hospital."
In addition to the sponsors, the following Senators have signed
the Thomas/Conrad letter:
Sens. Conrad Burns (R-Mont.), Maria Cantwell (D-Wash.), Hillary
Clinton (D-N.Y.), Norm Coleman (R-Minn.), Mark Dayton (D-Minn.),
Byron Dorgan (D-N.D.), Russ Feingold (D-Wis.), Tim Johnson (D-S.D.),
Ted Kennedy (D-Mass.), John Kerry (D-Mass.), Frank Lautenberg (D-N.J.),
Carl Levin (D-Mich.), Patty Murray (D-Wash.), Ben Nelson (D-Neb.),
Barak Obama (D-Ill.), Ken Salazar (D-Colo.), Charles Schumer (D-N.Y.),
Debbie Stabenow (D-Mich.), Ron Wyden (D-Ore.).
The following members of congress have also signed the Nussle/Pomeroy
letter:
Reps. Ken Calvert (R-Calif.), Michael Capuano (D-Mass.), William
Delahunt (D-Mass.), Rosa DeLauro (D-Conn.), Phil English (R-Pa.),
Mike Ferguson (R-N.J.), Scott Garrett (R-N.J.), Jim Gerlach (R-Pa.),
Virgil Goode (R-Va.), Katherine Harris (R-Fla.), Stephanie Herseth
(D-S.D.), Maurice Hinchey (D-N.Y.), Rush Holt (D-N.J.), Randy Kuhl
(R-N.Y.), John Larson (D-Conn.), Frank LoBiondo (R-N.J.), Stephen
Lynch (D-Mass.), Jim McGovern (D-Mass.), John McHugh (R-N.Y.), Mike
McIntyre (D-N.C.), Michael McNulty (D-N.Y.), Dennis Moore (D-Kan.),
James Oberstar (D-Minn.), Butch Otter (R-Idaho), Bill Pascrell (D-N.J.),
Ron Paul (R-Texas), Donald Payne (D-N.J.), Collin Peterson (D-Minn.),
Todd Platts (R-Pa.), Jim Saxton (R-N.J.), Allyson Schwartz (D-Pa.),
Rob Simmons (R-Conn.), Mike Simpson (R-Idaho), Chris Smith (R-N.J.),
John Tanner (D-Tenn.).
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Senate Panel Votes to Expand Uses of Cord Blood
Stem Cells
The Senate Health, Education, Labor, and Pensions (HELP) Committee
June 29 approved a bill to expand the use of cord blood stem cells
in transplants and for research. The "Stem Cell Therapeutic
and Research Act of 2005" (S.
1317), which the committee passed by voice vote, incorporates
an earlier cord blood bill (S.
681) with language from a broader House-passed bill (H.R. 2520)
that would help improve recruitment and collection procedures in
the bone marrow program. Original cosponsors of S. 1317 include
Senators Orrin Hatch (R-Utah), Chris Dodd (D-Conn.), Richard Burr
(R-N.C.), Jack Reed (D-R.I.) and John Ensign (R-Nev.). In a statement
released after passage of S. 1317, Senator Hatch noted it "has
been developed in close consultation with the House of Representatives
and is expected to pass Congress and reach President Bush's desk
this summer."
S. 1317 would create a national network of cord blood banking centers
and establish an inventory of 150,000 cord blood stem cell units
to provide a resource for those in need of transplants as well as
to sustain further research on cord blood stem cells. The bill also
reauthorizes the National Marrow Donor Program, creates a demonstration
program for families with sick children and establishes a patient
advocacy program for both bone marrow and cord blood. In addition,
it includes recent recommendations from the Institute of Medicine
on a national cord blood program and places cord blood and bone
marrow under a single program.
At a press conference following the cord blood bill markup Senators
Hatch, Gordon Smith (R-Ore.), Tom Harkin (D-Iowa), Edward Kennedy
(D-Mass.), Dianne Feinstein (D-Calif.) and Debbie Stabenow (D-Mich.)
expressed their continued support for legislation (S.
471/H.R.
810) to expand federal funding for research involving human
embryonic stem cells. The House passed H.R. 810 on May 24 - the
same day it passed the cord blood bill [see Washington
Highlights, May 27]. Senate
Majority Leader Bill Frist (R-Tenn.) has pledged to hold a vote
on stem cell legislation in July; however, the bill or bills to
be voted on are still under discussion.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
NRC Assessment of NIH Minority Research Programs
Do the NIH minority research training programs work? In an NIH-sponsored
report, "Assessment of NIH Minority Training Programs: Phase
3," a panel of the National Academies' National Research Council
set out address this question by analyzing NIH minority trainee
educational and career outcomes. Part of a three phase study, this
report highlights the benefits the programs offer to trainees and
the national interest, while emphasizing the need for an ongoing
and rigorous evaluation process to facilitate program improvement.
John Bailer, III, M.D., Ph.D., professor emeritus of Health Studies
at the University of Chicago, and Willie Pearson, Jr., Ph.D., professor
and chair of the School of History, Technology and Society at the
Georgia Institute of Technology, co-chaired the study.
Minority researchers continue to be underrepresented in the sciences.
The report
notes, that in 1997, underrepresented minorities represented only
4.2 percent of the doctoral-level biomedical workforce. To enhance
the number of minority biomedical and behavioral scientists, since
the early 1970s, the NIH has been supporting minority-targeted research
training programs. The study evaluated 47 minority programs that
span the undergraduate, graduate, postdoctoral, and junior faculty
career stages. The report laments the lack of available career outcomes
data to assess fully the effectiveness of the programs. However,
through extensive data mining of existing NIH electronic trainee
data sets, interviews with former trainees, and interviews with
program administrators, the committee concludes that underrepresented
minorities are entering the biomedical workforce as a direct result
of NIH minority research training programs.
To address some of the assessment difficulties that the committee
faced, the report makes several specific recommendations to facilitate
future program evaluation needs: a committee of minority training
program coordinators should establish appropriate guidelines and
measures for evaluating NIH minority research training programs;
the director of NIH training should administer funds for evaluation,
data collection, and marketing; and the NIH should develop of a
relational database that collects a minimum data set for all persons
who receive funding as trainees, fellows, research assistants, or
postdoctorates, including those programs targeted to underrepresented
minorities. In addition, the report recommends that NIH should commit
to the continued funding of minority-targeted research training
programs because of the vital research experiences, financial support,
and mentoring that the training programs provide.
Information:
Jodi Lubetsky, Staff Associate
AAMC Division of Biomedical and Health Sciences Research
jlubetsky@aamc.org
202-828-0485.
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