Washington Highlights: October 7,
2005
Contents
Prior Issues
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Bush, GOP Leaders Target Mandatory and Discretionary
Spending For Hurricane Offsets
In response to the President's call to find spending offsets for
hurricane relief from both mandatory and discretionary programs,
the chair of the House Budget Committee reportedly is seeking an
across-the-board cut of appropriations as well as additional savings
through the budget reconciliation process.
At an Oct. 4 press conference, the President stated, "Congress
needs to pay for as much of the hurricane relief as possible by
cutting spending.… I will ask them to make even deeper reductions
in the mandatory spending programs than are already planned. As
Congress completes action on the 2006 appropriations bills, I call
on members to make real cuts in non-security spending."
In response to Bush's statement, House Budget Committee Chairman
Jim Nussle (R-Iowa) reportedly is considering amending the FY 2006
budget resolution (H.Con.Res.
95) to require a 2 percent across-the-board cut of discretionary
spending programs, including defense, to achieve $16.8 billion in
savings. Nussle's amendment also would instruct the authorizing
committees to find another $3.5 billion in savings from mandatory
programs as part of this year's budget reconciliation package. The
budget resolution originally called for almost $35 billion in savings
through budget reconciliation. Authorizing committees have an Oct.
19 deadline for submitting their recommended cuts to the Budget
Committee.
While the Senate is less likely to go along with an amendment to
the budget resolution, Senate Budget Committee Chair Judd Gregg
(R-N.H.) and other Senate Republican leaders issued Sept. 28 letters
to committee chairs asking them to "consider additional policy
changes that can be used to help contain the massive federal recovery
costs associated with the recent devastating Gulf Coast hurricanes."
At the same time, Senate Finance Committee Chair Charles Grassley
(R-Iowa) questions whether he could get more than $10 billion in
savings out of his committee. Grassley is seeking floor time for
consideration of his Katrina health care relief package (S.
1716) [see Washington Highlights, Sept.
23], but has met opposition from the Administration and conservative
Senators for its cost.
Meanwhile, House Democrats continue to urge that the budget reconciliation
process be cancelled so Congress can focus on passing legislation
to provide relief to the Gulf Coast. An Oct. 5 letter to Nussle
and House Speaker Dennis Hastert (R-Ill.) from House Minority Leader
Nancy Pelosi (D-Calif.) and House Budget Committee Ranking Minority
Member John Spratt (D-S.C.) suggests that canceling reconciliation
would actually reduce the deficit by $35 billion, in part by avoiding
proposed tax cuts. The letter states, "We disagree with Republicans
who are using Katrina as a rationale to justify reconciliation cuts
to safety net programs. While we are deeply committed to fiscal
responsibility, we don't understand why many Republicans believe
that helping victims of Katrina meet their urgent needs and rebuilding
the Gulf Coast require an offset, but rebuilding Baghdad or giving
tax cuts to the wealthy does not." Senate Minority Leader Harry
Reid (D-Nev.) echoed similar remarks in an Oct. 4 floor statement.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Physician Group Letter, Ways and Means Hearing
Focus on Payment Issues
The AAMC joined over 120 physician specialty societies and state
medical societies in signing an Oct.
3 letter to Senate Majority Leader Bill Frist (R-Tenn.) and
House Speaker Dennis Hastert (R-Ill.) urging Congressional action
to "avert the looming cuts in Medicare physician payments."
The letter discourages passage of a temporary freeze in physician
payments, calling such a strategy "akin to a payment cut,"
since practice costs are expected to grow by 2.7 percent in CY 2006
(according to Medicare Economic Index projections). Warning that
"time is running out," the letter also encourages Frist
and Hastert to "convince the Administration to do its part"
by agreeing to exclude Part B drug expenditures from the Sustainable
Growth Rate (SGR) methodology.
CMS Administrator Mark McClellan, M.D., Ph.D. did not address the
likelihood of such regulatory changes during a Sept. 29 Ways and
Means Health Subcommittee hearing on "value-based purchasing"
for Medicare physician services. He did, however, testify that CMS
had made "substantial progress" in establishing quality
measures for physicians in the Medicare program. According to McClellan,
"[W]e now have 66 quality measures for 29 specialties,"
with those 29 specialties accounting for "about 80 percent
of Medicare physician spending." McClellan added that, "[W]hile
we still have much work to do…we believe that we can make rapid
progress in very short order so that broad initial reporting of
measures…could begin as soon as 2006."
During the same hearing, Urban Institute Senior Fellow Robert Berenson
expressed concern that the Administration's "inflated expectations
about what pay-for-performance can achieve" has distracted
"both policy makers and the medical profession from addressing
what are increasingly apparent flaws in the resource-based relative
value scale (RBRVS) payment system." Berenson testified that
"important and largely overlooked issues in the underlying
payment system" have been "all but ignored in this debate"
and are "long overdue for attention."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
HHS Issues Proposed E-Prescribing Rules
On Oct. 5 Secretary of Health and Human Services Mike Leavitt announced
the publication of two proposed regulations that support adoption
of e-prescribing and electronic health records (EHRs).
The Centers for Medicare and Medicaid Services (CMS) is proposing
a regulation that creates exceptions to the physician self-referral
("Stark") law. The proposal establishes different standards
for "pre-interoperability" of EHRs and "post-interoperability."
The proposed definition of "interoperable" is the ability
of different information systems, software applications, and networks
to communicate and exchange information in an accurate, secure,
effective, useful, and consistent manner. Either pre- or post-interoperability,
the "permissible donors" of the hardware, software, and
related training would be hospitals to members of their medical
staffs (only physicians who routinely furnish services at the hospital);
group practices to physician members; PDP sponsors; and Medicare
Advantage (MA) plans.
Pre-interoperability, donors could provide software used solely
for transmission, receipt, or maintenance of EHRs; directly-related
training services; and must include an electronic prescribing component.
Post-interoperability, EHRs would have to be certified and could
include billing and scheduling software, provided that the core
function of the software is the EHR. By proposing different pre-
and post-interoperability standards, CMS recognizes that while interoperability
standards do not currently exist, it is anticipated that they will
be available in the future.
Secretary Leavitt also announced that in a separate rulemaking the
Office of the Inspector General (OIG) proposed a safe harbor for
arrangements involving the donation of technology for e-prescribing
health records. Arrangements that meet the requirements of the safe
harbor will not be considered to violate the anti-kickback law.
Both rules are on display at the Federal Register office and will
be published Oct. 11. A 60 day comment period will be provided.
CMS also announced that it will schedule an Open Door Forum (ODF)
early in the comment period to discuss the benefits and risks of
donating e-prescribing and EHR technology. ODFs can be attended
in person, or by phone, and are free.
In the next few weeks, the AAMC will be providing members with additional
information on the rules.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
HRSA Primary Care Training Advisory Committee
Meets, Announces New Members
The Advisory Committee on Training in Primary Care Medicine and
Dentistry met Sept. 27-28 to finish work on its fifth report on
outcomes measures and begin discussions of its sixth report, which
will focus on caring for vulnerable populations. The committee advises
and makes recommendations to the Secretary of Health and Human Services
on policies related to the family medicine, general internal medicine,
general pediatrics, general dentistry, pediatric dentistry and physician
assistant programs authorized under Title VII of the Public Health
Service Act.
Committee members elected Joseph A. Leming, M.D., a family physician
from Colonial Heights, Virginia, to be the new chair. Additionally,
seven other new members were announced:
- Diego Chaves-Gnecco, M.D., M.P.H., pediatric resident, Children's
Hospital of Pittsburgh, Pittsburgh, Pa.;
- William Alton Curry, M.D., F.A.C.P., associate dean for primary
care and rural health and professor of medicine, University of Alabama,
Birmingham, Ala.;
- Katherine A. Flores, M.D., family practice physician, Latino Center
for Medical Educational Research and California Area Health Education
Center, Fresno, Calif.;
- Perri Morgan, P.A.-C., M.S., academic coordinator, University of
Wisconsin Physician Assistant Program, Madison, Wis.;
- Lauren L. Patton, D.D.S., associate professor, University of North
Carolina School of Dentistry, Chapel Hill, N.C.;
- Surendra K. Varma, M.D., professor and vice chair of pediatrics,
Texas Tech University, Lubbock, Texas; and
- Karen Ann Krupala Gunter, physician assistant student, Baylor
College of Medicine, Houston, Texas.
During the public comment period, the AAMC presented its recommendations
for the upcoming reauthorization of the Title VII programs. Also
providing comments were representatives from the Academic Family
Medicine Advocacy Alliance, the American Dental Education Association,
and the American Academy of Pediatrics.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
Von Eschenbach Not Likely To Lead FDA Permanently
Secretary of Health and Human Services Mike Leavitt said Oct. 4
that Acting Commissioner Andrew von Eschenbach, M.D., probably will
not be named permanent Commissioner of the Food and Drug Administration
(FDA). According to Leavitt, Dr. von Eschenbach is likely to resume
his position as Director of the National Cancer Institute (NCI)
when President Bush names a successor to Lester A. Crawford, who
resigned as FDA Commissioner last month.
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