Washington Highlights: July 8, 2005
Contents
Prior Issues
|
AAMC Urges Senate to Restore Eliminated Title
VII Programs
AAMC President Jordan J. Cohen, M.D., sent a June 29 letter
to all Senators urging the restoration of funding for the Title
VII health professions programs. Funding for all Title VII programs,
with the exception of $12 million for Centers of Excellence and
$35 million for the Scholarships for Disadvantaged Students (SDS)
program, was eliminated in the FY 2006 Labor, Health and Human Services,
and Education Appropriations bill (H.R.
3010) passed by the House on June 24.
The letter highlights the serious need for well-trained health
professionals, particularly in underserved areas. The AAMC also
signed onto a July
7 letter to the Senate organized by the Health Professions and
Nursing Education Coalition (HPNEC), asking for restoration of the
Title VII and VIII funds. The Senate Labor-HHS-Education Appropriations
Subcommittee is scheduled to consider its version of the appropriations
bill July 12, with full Committee consideration on July 14.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
Finance Committee Hearing Focuses on Medicaid
Fraud, Waste, Abuse
The Senate Finance Committee held a two-day hearing June 28
and 29
to continue to seek-out potential Medicaid savings focused on program
fraud, waste, and abuse. In his opening statement, Committee Chairman
Charles Grassley (R-Iowa) argued that "even a small amount
of fraud, waste, and abuse is a big deal," given the magnitude
of the Medicaid program. However, according to Sen. Grassley, it
was "virtually impossible to put a number on exactly how much
fraud, waste, and abuse occur in Medicaid as a whole." Ranking
Minority Member Max Baucus (D-Mont.) agreed that Congress must ensure
"that Medicaid's dollars are spent appropriately," but
he also reminded his colleagues that there were also "many
legitimate reasons" for the growth in Medicaid.
During the hearing, Government Accountability Office (GAO) Healthcare
Director Leslie G. Aronovitz questioned the Centers for Medicare
and Medicaid Services' (CMS) "commitment to Medicaid fraud
and abuse control." A GAO
study released in conjunction with the hearing found that "the
dollar and staff resources allocated to oversight suggest that CMS's
level of effort was disproportionately small relative to the risk
of federal financial loss." Similarly critical of CMS was a
second GAO study
that identified a lack of oversight regarding states' use of contingency-fee
consultants to maximize Medicaid reimbursements. During the hearing,
Sen. Grassley announced plans to contact all state governors regarding
their use of such consultants.
Ohio Medicaid Director Barbara Coulter Edwards joined past Director
of the CMS Center for Medicaid and State Operations Timothy Westmoreland
in urging caution as Congress considers proposals to restrict the
mechanisms by which states access federal Medicaid dollars (e.g.,
intergovernmental transfers). Ms. Coulter Edwards urged Congress
to make sure that states "have clear standards" and "formally
promulgated rules that spell out the parameters of our fiscal responsibilities…."
Both she and Mr. Westmoreland also called for "consistent application
of the rules." Mr. Westmoreland expressed concern that the
Bush Administration is "making ad hoc and variable decisions"
in its review of state financing mechanisms. He argued that the
Administration "has never defined what is abusive and what
is not…."
Also during the hearing, several witnesses expressed strong support
for proposals to reform Medicaid drug reimbursement policies and
restrict the use of asset transfers related to long-term care benefits.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senators Introduce Legislation Linking Medicare
Payments to Quality
Senate Finance Committee Chair Chuck Grassley (R-Iowa) and Ranking
Minority Member Max Baucus (D-Mont.) June 30 introduced S.1356,
the "Medicare Value Purchasing Act of 2005," requiring
the Secretary of Health and Human Services to develop and implement
"value-based purchasing programs" under Medicare. The
purpose of the bill is to link a percentage of Medicare payments
for physicians, hospitals, health plans, skilled nursing facilities,
home health, and end stage renal disease facilities to quality measures.
The Secretary would be given the authority to select measures of
quality to be used for each program for the different providers.
The selected measurements, in consultation with provider input,
would be based on a range of criteria established in the legislation
and could be varied according to the size and scope of hospitals
and to physician specialty and practice size. Such measures would
be weighted for clinical effectiveness and risk-adjusted.
While the program would be voluntary, providers not participating
in the program would receive a reduction to their updates. Specifically,
in FY 2007 and thereafter, hospitals not participating in the program
would see their payment updates be reduced by 2 percentage points.
Those hospitals participating in the program would receive a full
update, as well as be eligible to receive payments from a quality
pool financed through a reduction in Medicare inpatient payments
of the reporting hospitals. The quality payments would then be redistributed
to those hospitals based on certain thresholds of quality performance
or quality improvement, as determined by the Secretary.
For physicians, beginning in 2006, a comparative utilization system
to measure resource use would be established based on claims data
and shared confidentially with physicians in 2006 and 2007. Beginning
in FY 2007, physicians not reporting on quality measures as determined
by the Secretary would receive an update reduced by 2 percentage
points. Physicians reporting quality data would receive a full update
to the Medicare payment according to current law. Beginning in 2008,
physicians would be eligible to receive payments from a quality
pool financed through reductions from the conversion factor of physicians
reporting the quality measures. The quality payments would then
be redistributed to those physicians based on certain thresholds
of quality performance or quality improvement as determined by the
Secretary and efficiency of care provided according to the comparative
utilization system. In addition, the Secretary shall establish procedures
for making the data submitted by physicians available to the public.
While the bill does not include provisions to fix the flawed Medicare
physician sustainable growth rate formula, the bill does include
a "Sense of the Senate" acknowledging the problem and
calling for a long-term strategy to address the problematic formula.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Senate Hearings, Legislation Focus on Health IT
The Senate Commerce, Science, and Transportation Subcommittee on
Technology, Innovation, and Competitiveness held a June 30 hearing
to examine strategies to expedite the implementation of health information
technology (HIT). Witnesses included Health and Human Services National
Coordinator for Health Information Technology David Brailer, M.D.,
Ph.D.; Agency for Healthcare Research and Quality (AHRQ) Director
Carolyn Clancy, M.D.; and Acting Chief Informatics Officer for the
Veterans Health Administration Robert Kolodner, M.D.
Several witnesses from the provider, purchaser, and consumer communities
also testified,
including John Glaser, Ph.D., vice president and chief information
officer for Partners Healthcare in Boston. Dr. Glaser also serves
as Board President of eHealth Initiative, a diverse group of stakeholders
that strives to improve healthcare quality, safety, and efficiency
through implementation of HIT. During his testimony, Dr. Glaser
stated that the federal government "must play a critical role"
in promoting adoption of interoperable HIT. He urged the government
to "alter its Medicare reimbursement approaches" to ensure
that providers are "financially rewarded" for using HIT.
Dr. Glaser explained that providers "must bear 100 percent
of the costs" related to HIT, while "89 percent of the
economic benefit flows to groups and organizations other than the
provider."
Dr. Glaser also urged the federal government to "consider
changes in the Stark and Anti-Fraud laws" to allow large providers
to share costs and expertise with small practices. This proposal
was strongly opposed by Karen Ignani, who testified before the Subcommittee
on behalf of America's Health Insurance Plans (AHIP). According
to Ms. Ignani, "it would be a mistake to relax federal fraud
and abuse laws for the purpose of allowing hospitals to support
physician use of health information technology." Ms. Ignani
argued, "creating new exceptions to current fraud and abuse
laws is not only unnecessary, but will undermine the integrity of
the existing regulatory framework." She also expressed concern
"about the unintended consequences of tying physicians to hospitals
financially through equipment subsidies or electronic record sharing."
The hearing coincided with the introduction of S.
1355, the "Better Healthcare Through Information Technology
Act," by Senate Health, Labor, Education and Pensions Committee
Chairman Mike Enzi (R-Wyo.) and Ranking Minority Member Edward Kennedy
(D-Mass.). S. 1355 promotes the electronic exchange of health information
through development and implementation of interoperability and certification
standards. In addition, the bill authorizes a number of grant and
loan programs to encourage the widespread adoption and use of technology
among providers.
Specifically, not-for-profit hospital and physician group practices
would be eligible for matching grants in order to help purchase
and enhance the utilization of health information technology systems.
Grant preference would be given to those entities in rural, frontier,
or underserved areas. The bill authorizes $25 million in FY 2006,
$75 million in FY 2007 and such sums as necessary thereafter. The
bill's provisions also authorize grants to encourage the adoption
of information technology in the medical education system. Preference
would be given to community-based medical education programs as
well as programs that collaborate with 2 or more disciplines. The
bill authorizes "such sums as necessary" in FY 2006, $5
million in in FY 2007 and "such sums as necessary" in
FYs 2008-2010. Lastly, S. 1355 includes provisions to allow providers
to share health information technology without violating "Stark"
and anti-kickback laws.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Waxman, Markey Reintroduce Clinical Trials Information
Bill
Reps. Henry Waxman (D-Calif.) and Edward Markey (D-Mass.) June
30 reintroduced legislation to provide greater public access to
basic information on clinical trials involving drugs, biologics,
and medical devices. The "Fair Access to Clinical Trails (FACT)
Act" (H.R. 3196) is similar to the bill Reps. Waxman and Markey
introduced in the 108th Congress. The bill would expand on the National
Library of Medicine's clinicaltrials.gov database. Sponsors would
be required to register all privately and publicly funded studies
of drugs, biologics, or medical devices with safety or effectiveness
endpoints. The registry will not include drug or biologic studies
designed solely to detect major toxicity (phase 1 studies) and pharmacokinetic
studies other than those in special populations. Studies must be
registered as a condition of obtaining Institutional Review Board
(IRB) approval.
Within 12 months from the last data collection, the sponsor must
provide a summary of the clinical trials results. H.R. 3196 grants
the Secretary authority to impose severe penalties for noncompliance
if trial sponsor fails to submit required information to the database
or submits false or misleading information. Penalties can include
revoking eligibility for future federal funding, refusing to grant
future Investigational New Drug (IND) applications, and imposing
civil money penalties of up to $15,000 for individuals or non-profit
institutions and $10,000 per day for for-profit companies.
H.R. 3196 is similar to legislation (S.
470) introduced in late February in the Senate by Senator Chris
Dodd (D-Conn.) [see Washington Highlights, March
4]. A total of 30 Representatives have cosponsored H.R. 3196,
which has been referred to the House Committee on Energy and Commerce.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Survey Indicates Public Support for Medicaid Program,
Opposition to Cuts
In a new public opinion survey
conducted by the Kaiser Family Foundation, nearly three-quarters
of respondents identified Medicaid as a "very important"
government program. Released on June 29, the national telephone
survey also found that 44 percent of respondents thought the federal
government should maintain current Medicaid funding levels; over
one-third (36 percent) thought the federal government should increase
funding levels.
According to a June 29 press release, the Kaiser Family Foundation
organization "expected Medicaid to be relatively unpopular
with the public…. But we found that Medicaid ranks closer to
popular programs like Medicare and Social Security in the public's
mind."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Agwunobi Nominated to be ASH
President Bush June 30 announced the nomination of John Agwunobi,
M.D., to be the next Assistant Secretary for Health (ASH) at the
Department of Health and Human Services (HHS). Dr. Agwunobi currently
serves as Secretary and State Health Officer at the Florida Department
of Health, and previously served as Vice President of Medical Affairs
and Patient Services at the Hospital for Sick Children in Washington,
DC. As a pediatrician, Dr. Agwunobi has practiced medicine in rural,
inner city and suburban communities. He received his medical degree
from the University of Jos, Nigeria; his first master's degree from
Georgetown University; and his second master's degree from Johns
Hopkins University. Cristina Beato, M.D., FAAFP, has served as Acting
Assistant Secretary for Health since July 2003.
Leavitt Names Medicaid Commission
Secretary of Health and Human Services Secretary Mike Leavitt July
8 announced 13 voting members and 15 non-voting members of an advisory
commission charged with identifying reforms necessary to stabilize
and strengthen Medicaid. Two additional voting positions are being
reserved for current governors and will be filled after Sept. 1,
2005. Creation of the commission was prompted by a provision in
the FY 2006 budget agreement.
Members of the commission include Republican and Democratic health
policy leaders, state health department officials, public policy
organizations, individuals with disabilities and others with special
expertise. Hospital and physician interests are primarily represented
by the non-voting members.
The commission is charged with outlining
recommendations by Sept. 1 for Medicaid to achieve $10 billion in
reductions in spending growth during the next five years as well
as ways to begin meaningful long-term enhancements that can better
serve beneficiaries. The first report also will consider potential
performance goals for Medicaid as a basis of longer-term recommendations.
A second report, due Dec. 31, 2006, will provide recommendations
to help ensure the long-term sustainability of Medicaid.
Former Tennessee Governor Don Sundquist will chair the commission
and former Maine Governor Angus King will serve as vice-chair. The
commission members are:
-
Nancy Atkins, commissioner for the Bureau for Medical Services,
Department of Health and Human Resources, West Virginia;
- Melanie Bella, vice president for policy, Center for Health
Care Strategies, Inc.;
- Gail Christopher, vice president for health, Women and Families
at the Joint Center for Political and Economic Studies and director
of the Joint Center Health Policy Institute;
- Gwen Gillenwater, director for advocacy and public policy, National
Council on Independent Living;
- Robert Helms, resident scholar and director of health policy
studies, American Enterprise Institute;
- Kay James, former director of the U.S. Office of Personnel Management;
- Troy Justesen, deputy assistant secretary for the office of
special education and rehabilitative services, U.S. Department
of Education;
- Tony McCann, secretary of health and mental hygiene, Maryland;
- Mike O'Grady, assistant secretary for planning and evaluation,
U.S. Department of Health and Human Services;
- Bill Shiebler, former president, Deutsche Bank; and
- Grace-Marie Turner, president, Galen Institute.
In addition to the voting members, the commission will consist of
the following non-voting members:
- James Anderson, president and CEO, Cincinnati Children's Hospital
Medical Center, National Association of Children's Hospitals;
- Julianne Beckett, director of national policy, Family Voices;
- Carol Berkowitz, president, American Academy of Pediatrics;
- Maggie Brooks, county executive, Monroe County, New York;
- Valerie Davidson, executive VP, Yukon-Kuskokwim Health Corporation;
- Mark de Bruin, senior VP of pharmacy services, Rite Aid; chairman
of the policy council, National Association of Chain Drug Stores;
- John Kemp, CEO, Disability Service Providers of America;
- Joseph Marshall, chairman and CEO, Temple University Health
System, American Hospital Association;
- John Monahan, president of state sponsored programs for WellPoint;
Blue Cross/Blue Shield Association and America's Health Insurance
Plans;
- John Nelson, M.D., immediate past-president of the American
Medical Association;
- Joseph J. Piccione, corporate director of mission integration,
OSF Healthcare System;
- John Rugge, CEO, Hudson Headwaters Health Network, National
Association of Community Health Centers;
- Douglas Struyk, president and CEO, Christian Health Care Center,
American Health Care Association/National Center for Assisted
Living and American Association of Homes and Services for the
Aging;
- Howard Weitz, M.D., cardiologist, Thomas Jefferson University;
and
- Joy Johnson Wilson, director of health policy and federal affairs
counsel, National Conference of State Legislators.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
|
