Washington Highlights: September
16, 2005
Contents
Prior Issues
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Senate, House Delay Budget Deadline
In the wake of Hurricane Katrina, both the Senate and House have
formally postponed until the end of October the deadlines for their
respective Budget committees to report legislation to cut mandatory
spending by nearly $35 billion over the next five years. Under the
terms of the FY 2006 budget resolution approved in April, the Budget
committees were to report reconciliation bills to reduce mandatory
spending by $34.7 billion over 5 years by Sept. 16.
Senate Majority Leader Bill Frist (R-Tenn.) and Senate Budget Committee
Chair Judd Gregg (R-N.H.) released a joint statement Sept. 12 delaying
until Oct. 26 the deadline for the Senate Budget Committee to report
its mandatory spending reconciliation bill. The House joined the
Senate Sept. 13 when Budget Committee Chair Jim Nussle (R-Iowa)
informed the authorizing committees that his committee would mark
up its spending reconciliation bill the week of Oct. 24. The authorizing
committees, which have jurisdiction over the programs slated for
spending cuts, must report their recommendations to the Budget committees
about a week ahead of the reporting deadline to permit budget committee
staff time to assemble the proposals into a single bill
GOP leaders were concerned that postponing the deadline established
in the budget resolution would strip the reconciliation bill of
the special protections it enjoys from filibusters on the Senate
floor. However, the Senate Parliamentarian has indicated the decision
to delay "will not jeopardize the privileged status of any
reported reconciliation bill."
But delaying the budget deadline may not make the task of passing
the spending cuts any easier as Democrats and moderate Republicans
are lining up to oppose efforts to reduce programs such as Medicaid
and other programs for the poor that are likely targets for spending
cuts in the reconciliation bill. Republican leaders insist that
reforming entitlement programs to make them more efficient is even
more necessary now because of the anticipated costs of the Katrina
relief and rebuilding efforts.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Panel Presents to MedPAC on Pay-for-Performance
At the Sept. 8-9 meeting
of the Medicare Payment Advisory Commission (MedPAC), a panel of
industry experts presented their perspectives of using quality measures
and pay-for-performance (P4P) for private plans.
The panelists were Jack Ebeler, President and Chief Executive Officer
of the Alliance of Community Health Plans (ACHP); Samuel Nussbaum,
M.D., Executive Vice President and Chief Medical Officer of Wellpoint,
Incorporated; and Peggy O'Kane, President and founder of the National
Committee for Quality Assurance (NCQA).
MedPAC specifically requested this panel to review incorporating
quality measures into Medicare Advantage plans, but the discussion
expanded to the implications of pay-for-performance in the Medicare
fee-for-service program and potential measuring of quality across
payers and communities. Panelists discussed the importance of measure
selection and implementation. All three panelists also emphasized
the importance of incentive design.
When questioned further by the commissioners about financing incentives,
panelists mentioned that perceived or actual reductions would not
be well received. Some recommendations for funding pay-for-performance
could include withholding increases,
or funding an incentive pool from the savings of the programs. Some
panelists noted that the size of the incentive needs to be great
enough to influence behavior. No formal recommendations regarding
pay-for-performance were discussed by the commission, but they plan
to continue evaluating P4P options.
Other topics discussed at the two-day meeting include: valuing services
in the physician fee schedule, measuring physician resource and
quality, analysis of home health care margins and case-mix, growth
in outpatient therapy spending, review of Maryland hospital rate
setting, review of Medicare's adjustments for geographic differences
in underlying wage levels, and review Medicare payment changes on
oncology services.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Congress Passes Student Aid Forgiveness Legislation
In Response to Hurricane Katrina
As a result of numerous school closings in the path of Hurricane
Katrina, the House moved Sept. 8 to provide relief to students forced
to withdraw from schools closed due to natural disasters. The House
unanimously approved the "Student Grant Hurricane and Disaster
Relief Act" (H.R.
3668), proposed by Rep. Bobby Jindal (R-La.), which gives the
Secretary of Education the ability to waive the Title IV federal
assistance programs' repayment requirements when a natural disaster
is recognized by the President. The Senate passed H.R. 3668 without
amendment by Unanimous Consent on Sept. 15.
"This bill fulfills an urgent need to provide flexibility
and assistance to students who have been forced to put their higher
education on hold as a result of Hurricane Katrina," said Rep.
Jindal. "Students in my district are facing hardships on numerous
fronts, from the loss of their homes and communities to the damage
and closure of college campuses. As students cope with these unprecedented
challenges, we should not add to their burden by requiring those
who have been forced to withdraw from college to repay student aid."
Under current law, students with grants and scholarships offered
under Title IV federal assistance programs (including Pell Grants,
the Supplemental Educational Opportunity Grant program, Leveraging
Educational Assistance Partnerships program, and scholarships offered
under the GEAR UP and TRIO programs) must repay the awarded funds
if they fail to complete the required academic year or semester.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
HHS Secretary Names AHIC Commissioners
Secretary of Health and Human Services Mike Leavitt Sept. 13 named
16 commissioners to serve on the American Health Information Community
(AHIC). During
their two-year terms, the commissioners will advise the Secretary
on how to assure broad-based adoption of interoperable electronic
health records within the next 10 years. Secretary Leavitt will
chair the AHIC, which has scheduled its first meeting for Oct. 7.
According to a press release, Secretary Leavitt said he "selected
commissioners who represent key interests and have the broad support
of their peers." In the press release, National Coordinator
for Information Technology David Brailer, M.D., added that the "public-private
nature of this group is designed to ensure that this nationwide
transition to electronic health records…occurs in a smooth,
market-led way."
The AHIC commissioners include:
- Scott Serota, President/CEO, Blue Cross Blue Shield Association;
- Douglas Henley, M.D., Executive Vice President, American Academy
of Family Physicians;
- Lillee Smith Gelinas, RN, Chief Nursing Officer, VHA Inc.;
- Charles Kahn III, President, Federation of American Hospitals;
- Nancy Davenport-Ennis, CEO, National Patient Advocate Foundation;
- Steven Reinemund, CEO/Chairman, PepsiCo;
- Kevin Hutchinson, CEO, SureScripts;
- Craig Barrett, Chairman, Intel Corporation;
- E. Mitchell Roob, Secretary, Indiana Family and Social Services
Administration;
- Mark McClellan, M.D., Administrator, Centers for Medicare and
Medicaid Services;
- Julie Gerberding, M.D., Director, Centers for Disease Control
and Prevention;
- Jonathan Perlin, M.D., Under Secretary for Health, Department
of Veterans Affairs;
- William Winkenwerder Jr., M.D., Assistant Secretary of Defense;
- Mark Warshawsky, Assistant Secretary for Economic Policy, Department
of Treasury;
- Linda Springer, Director, Office of Personnel Management; and
- Michelle O'Neill, Acting Under Secretary for Technology, U.S.
Department of Commerce.
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
COGME Discusses Potential Report Topics
The Council on Graduate Medical Education (COGME),
which last met in July 2004, convened Sept. 13-14 to discuss topics
for future reports, receive information regarding physician workforce
issues and listen to public comments.
Council members spent significant time considering topics that
could be the subject of future COGME reports including the role
of graduate medical education (GME) training in enhancing patient
access to physicians, flexibility regarding GME training opportunities,
and the economics and financing of GME. The members chose two topics
for future reports: whether a voluntary or mandatory National Service
for medical professionals would be appropriate as a way for physicians
to give back to society in return for the benefit of acquiring medical
education and what policy changes can be made with regard to GME
funding to facilitate more flexible graduate medical education training.
The council also heard a presentation by Saralyn Mark, M.D., senior
medical advisor at the Department of Health and Human Services Office
on Women's Health, who presented a number of recommendations to
facilitate re-entry into the physician workforce, including:
- collecting data on the number of inactive health care professionals
who intend to re-enter a clinical career;
- developing an institutional database and a national directory
of re-entry programs;
- learning from nursing re-entry programs;
- conducting program evaluations;
- exploring means to advertise and recruit for the program;
- making re-entry programs mandatory;
- looking at ways in which re-entry programs can address educational
and personal needs; and
- exploring the possibility of requiring graduates of federally
funded re-entry programs to provide services to an underserved
community for at least one year after graduation.
The council decided to raise the issue of workforce re-entry at
its next meeting, although concern was expressed that more specific
data are needed (i.e., number of physicians re-entering the workforce)
in order for COGME to make specific recommendations in this area.
During the public comment period, there were additional suggestions
for topics for COGME consideration, such as how non-physician health
care providers (i.e., physician assistants, nurse practitioners)
can affect the responsibilities of physicians in the delivery of
patient care and the effect of gender on physician work-related
decisions, including work hours and choice of medical specialty.
The next meeting will be held in April 2006.
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
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