Washington Highlights: March 24,
2006
Contents
Prior Issues
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Senate Debates Medicare Spending as Part of FY
2007 Budget Resolution
During its floor debate on the FY 2007 Budget Resolution (S.Con.Res.
83), the Senate rejected an amendment that would have cut overall
Medicare spending and approved an amendment to create a deficit
neutral reserve fund for Medicare physician payment increases.
Specifically, the Senate voted 43-57 to reject an amendment (S.Amdt.
3100) offered by Sen. John Cornyn (R-Texas) that included reconciliation
instructions for the Finance Committee to identify $10 billion in
mandatory program savings over FYs 2008 - 2011 (i.e., no cuts in
FY 2007). While S.Amdt. 3100 did not specify which programs would
be targeted, it did reduce Medicare outlays by $5 billion over 4
years (FY 2008 - FY 2011). Sen. Ben Nelson (D-Neb.) was the only
Democrat voting in support of the amendment, while 13 Republicans
voted in opposition: Senators Lincoln Chafee (R.I.), Norm Coleman
(Minn.), Susan Collins (Maine), Mike DeWine (Ohio), Kay Bailey Hutchison
(Texas), Richard Lugar (Ind.), Mel Martinez (Fla.), Lisa Murkowski
(Alaska), Gordon Smith (Ore.), Olympia Snowe (Maine), Arlen Specter
(Pa.), Ted Stevens (Alaska), and Craig Thomas (Wyo.).
The Senate did approve by voice vote an amendment offered by Sen.
Kay Bailey Hutchison (R-Texas) to add a reserve fund that would
allow the Senate to consider future legislation to "ensure
that physicians will receive an appropriate reimbursement rate under
Medicare instead of a scheduled cut." The reserve fund specifies
that the proposal be deficit neutral in FYs 2007-2011. The amendment
was cosponsored by Senators Jon Kyl (R-Ariz.), Dianne Feinstein
(D-Calif.), Susan Collins (R-Maine), Elizabeth Dole (R-N.C.) and
John Cornyn (R-Texas).
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
Leavitt Announces Health Care Transparency Initiative
In a March 14 speech to the Commonwealth Club of California, Secretary
of Health and Human Services Michael Leavitt announced his intention
to create real transparency in quality and price in health care
to ensure that every consumer can look for the best value.
Sec. Leavitt stated, "I am announcing today that for the first
time, Medicare, Medicaid, the Department of Defense (VA and OPM/FEHBP),
and the Office of Personnel Management will compile non-personalized
claims information and release the information in sufficient detail
that a statistically reliable foundation of transparent price and
quality data will be available for each hospital and doctor. We
will start with a few of the most common procedures and expand as
quickly as possible."
The initiative outlined by Sec. Leavitt includes the four following
components:
Quality Transparency: Public and private payers will be asked
to require insurers, third party administrators, and providers to
provide claims information and adopt Ambulatory Care Quality Alliance
(AQA) and Hospital Quality Alliance (HQA) standards, starting with
20 of the most frequently used procedures and measures of patient
satisfaction.
Price Transparency: Insurers and third party administrators will
be asked to disclose their prices on the most frequent medical procedures.
Leavitt stated, "to be most useful, consumers need a clear
picture of the overall cost, not just the procedure, but all of
the cost, when they choose a specific doctor or hospital."
Health Information Technology: Insurers, administrators and providers
will be asked to use an interoperable electronic "registration"
system.
Consumer-Oriented System: Payers will be encouraged to make health
savings accounts a voluntary option on their menu of health insurance
plans.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
House Panel Holds Hearing on Price Transparency
The House Energy and Commerce Health Subcommittee March 15 hearing
a hearing entitled, "What's the Cost: Proposals to Provide
Consumers with Better Information About Healthcare Service Costs."
Many of the hearing witnesses testified to the importance of increasing
transparency of health care pricing and quality information. It
is "essential to helping providers improve by benchmarking
their performance against others; encouraging private insurers and
public program to reward quality and efficiency; and helping patients
make informed choices about their care," stated Sara Collins,
Ph.D., Senior Program Officer, The Commonwealth Fund.
Representatives Dan Lipinski (D-Ill.) and Rahm Emanuel (D-Ill.)
discussed their separate bills (H.R.
3139 and H.R.
3546, respectively) that require hospital, ambulatory surgical
centers, and drug prices to be more transparent.
Additional witnesses addressed the pros and cons of increasing
transparency of health care pricing and quality information. Gerard
Anderson, Ph.D., professor, Johns Hopkins, reminded the panel that
in order for patients to compare prices, they need to know what
"goods and services" they are buying. He stated, "in
health care it is difficult to predict in advance what good and
services will be needed and doing comparison shopping while a procedure
is being done is not generally feasible." Recommending that
published "prices…reflect market forces," Dr. Anderson
suggested that rates be compared or based on a single price standard,
such as the Medicare payment rate.
Paul Ginsberg, Ph.D., president, Center for Studying Health System
Change, suggested that health plans can be "a key agent"
in helping consumers obtain better value. However, he warned that
policies to "force extensive disclosure of contracts between
managed care plans and providers may backfire by leading to higher
prices." Further, Dr. Ginsberg urged that government not interfere
with the relationship between the insurance plan and consumer and
"focus instead on the needs of those without insurance."
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
House Panels Discuss Ways to Expedite Adoption
of Health IT
Congress continued to explore options for promoting the adoption
of health information technology (HIT) during two House subcommittee
hearings on March 15 and 16.
Testifying at the March
15 hearing before the Government Reform Subcommittee on Federal
Workforce and Agency Organization, former House Speaker Newt Gingrich
urged Congress to reform the Stark and Anti-Kickback laws to allow
hospitals and health systems to provide community physicians and
other entities with HIT hardware, software, and expertise. Gingrich
also expressed support for newly introduced legislation (H.R.
4859) that would require all insurers in the Federal Employees
Health Benefit Program (FEHBP) to implement electronic health records.
Gingrich also testified that all Americans have "the fundamental
right to know the price and quality of health and healthcare services
before [sic] making a purchasing decision." He added
that "wired" hospitals and physician offices "can
easily capture and report price and quality information."
During the March
16 hearing before the Energy and Commerce Subcommittee on Health,
Evanston Northwestern Healthcare CEO Mark Neaman similarly urged
Congress to support HIT-related reforms to the Stark and Anti-Kickback
laws. While Neaman testified on behalf of the Healthcare Leadership
Council (HLC), his remarks reflected Northwestern's own experiences
and concerns.
Testifying on behalf of Consumers Union, Senior Policy Analyst
Bill Vaughn expressed concern about altering the Stark and Anti-kickback
laws. Vaughn believes that, either consciously or subconsciously,
community physicians will likely favor a hospital for providing
low-cost or free HIT.
Also during the March 16 hearing, Rep. Lois Capps (D-Calif.) expressed
concern that providers might share patients' electronic health data
for research purposes, without obtaining patient consent. Witness
James Pyles, an attorney testifying on behalf of the American Psychoanalytic
Association, raised questions about liability when physicians can
not immediately access electronic records because of network problems.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Supreme Court Hears Arguments on Medical Test
Patent
The U.S. Supreme Court March 21 heard arguments on the case of
LabCorp v. Metabolite, concerning a patent on a medical diagnostic
test. LabCorp, a diagnostic laboratory, has been judged in lower
courts to have infringed the patent by correlating blood homocysteine
levels with B-vitamin deficiency, even when the company employed
a test other than the method described in the patent. In effect,
the patent extends, by virtue of a single claim, to the correlation
between homocysteine and B-vitamin deficiency.
In December, the AAMC joined the AMA and other medical organizations
in an amicus filing supporting LabCorp, arguing that laws or phenomena
of nature are not patentable subject matter [see Washington Highlights,
Jan. 6].
The case has received much national attention, including a commentary
and editorial in the New York Times on March 20 and 22.
According to press accounts of the Supreme Court's hearing, the
justices expressed some caution about reviewing patentable subject
matter because such a question had not been examined in the lower
courts. The Associated Press (AP) reported that Metabolites' counsel
did affirm that a physician who orders a test and uses the results
to determine a deficiency of B vitamin levels infringes the patent.
The AP further reported, "Justice Stephen Breyer said allowing
doctors, scientists and computer experts to begin patenting every
'useful idea' could establish 'monopolies beyond belief.'"
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
CNSF Thanks President Bush for ACI
The Coalition for National Science Funding (CNSF) March 20 sent
a letter
to President Bush, thanking him for including increased National
Science Foundation (NSF) funding in the FY 2007 Administration Budget
Request and as part of the American Competitiveness Initiative (ACI).
As a CNSF member, the AAMC was joined on the letter by over 100
other professional societies, universities, and corporations. White
House Chief of Staff Andrew Card, Jr. and Office of Management and
Budget Director Joshua Bolten also received copies. The letter highlights
NSF's contribution to global competitiveness and scientific advances
such as magnetic resonance imaging and genome sequencing.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
On The Hill
Representatives Sherwood Boehlert (R-N.Y.), chair of the House
Science Committee, and Martin Sabo (D-Minn.), a senior member of
the Committee on Appropriations, announced that they will retire
at the end of the 109th Congress.
Because of the Republican 6-year term limits for committee chairman,
Boehlert was scheduled to relinquish his gavel at the end of this
Congress. His retirement follows reports that House GOP leaders
are considering abolishing the Science Committee as part of a plan
to reorganize the committee structure, as well as a recent heart
bypass surgery after the 12-term Congressman won re-election in
2004.
Rep. Sabo, a 14-term Congressman, served as chairman of the House
Budget Committee in the early 1990s and this year marks his 46th
consecutive year in elected office.
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