Washington Highlights: May 19, 2006
Contents
Prior Issues
|
AAMC Testifies on Physician Workforce Shortages
Edward Salsberg, Director of the AAMC Center for Workforce Studies,
testified
at a May 18 hearing
before the House Judiciary Subcommittee on Immigration, Border Security,
and Claims. The hearing focused on the "Physicians for Underserved
Areas Act" (H.R.
4997), which seeks to make permanent a program that grants J-1
visa waivers to international medical graduates who commit to serving
in medically underserved areas.
Mr. Salsberg presented the history of physician supply, the likelihood
of a future physician shortage, and the AAMC recommendations
on improving physician supply. He noted that the aging of both the
physician workforce and the general population will bring about
a national shortage of physicians by 2020. The AAMC is recommending
a 15 percent increase in U.S. medical school graduates by 2015 to
address this predicted shortage, as well as an expansion of the
National Health Service Corps to improve access to care in underserved
areas. To accommodate the increase in medical school enrollment,
the AAMC also recommends increasing the cap on physician residents
supported by Medicare.
Also testifying were Rep. Jerry Moran (R-Kan.), sponsor of H.R.
4997; John B. Crosby, J.D., Executive Director of the American Osteopathic
Association; and Leslie G. Aronovitz, Director, Health Care, Government
Accountability Office.
Information:
Lynne Davis Boyle, Assistant Vice President
AAMC Government Relations
ldavisboyle@aamc.org
(202) 828-0526
House Passes Budget Plan
Shortly before 1 a.m. on May 18, the House approved its FY 2007
budget resolution (H.Con.Res.
376) after moderate Republicans secured a non-binding agreement
with the leadership calling for more funding for health and education
programs.
The moderates, led by Rep. Mike Castle (Del.), Nancy Johnson (Conn.),
and Dave Reichert (Wash.), had offered a substitute budget to increase
funding for the Labor-HHS-Education appropriation by $7.158 billion
to bring the bill to its FY 2006 level plus a 2 percent inflationary
increase. As a result of negotiations on that amendment, the moderates
secured a partial victory earlier this month when the House Appropriations
Committee agreed to transfer over $6 billion from the defense and
foreign operations accounts to domestic programs, including increasing
the allocation for the Labor-HHS-Education Subcommittee by $4.1
billion above the President's budget (see
Washington Highlights, May 12).
The budget resolution was amended to create a $3.1 billion reserve
fund for health, education, and other domestic priorities, but only
if these funds are offset by savings from other discretionary or
mandatory programs. Under an amendment by Rep. Curt Weldon (R-Pa.),
at least $1 billion of the offset for any increases for the Labor-HHS-Education
bill would come from unobligated funds for Iraq reconstruction.
The moderates also received assurances from the leadership that
the additional $3.1 billion would not come from Medicaid, Medicare
or other programs to help special populations.
Passage of the budget resolution permits the House to proceed with
consideration of the individual annual appropriation bills without
having to "deem" individual spending caps for each measure.
Although it is unlikely the House and Senate will resolve the differences
between their individual budget resolutions, the House can move
forward under the $873 billion discretionary spending cap imposed
in its budget plan.
The final vote on the budget was 218 to 210, with 12 Republicans
voting against the final package. No Democrat voted in favor of
the budget. During debate on the budget, the House rejected alternative
budget plans offered by the Democrats, the conservative Republican
Study Committee, and the Congressional Black Caucus.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
House Budget Requires $4 Billion in Savings from
Ways and Means; Urges Short-Term Physician Payment Fix
The House-passed budget resolution (H.Con.Res.
376) includes reconciliation instructions for the House Ways
and Means Committee, which oversees the Medicare program. Specifically,
the Committee must identify $4 billion in savings over 5 years.
While the reconciliation instructions do not specify which programs
should be cut, the report language accompanying H.Con.Res. 376 does
state that the budget resolution assumes no reductions in Medicare
or Medicaid.
The report language also states that the Sustainable Growth Rate
(SGR) methodology used to calculate Medicare physician payments
"does not accurately reflect physician services or beneficiary
utilization rates; and as such, physicians are scheduled to receive
a significant reduction in reimbursement…in FY 2007 and beyond."
The Budget Committee "recognizes the need to modernize and
stabilize physician payment," and it urges Congress "to
determine a fair short-term solution" for FY 2007, as well
as "a long-term solution…so the Congress need not address
the payment issue annually..." The report language also "recommends
that quality improvement initiatives be included in any physician
payment update..."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Hospital Groups Address New Medicaid Documentation
Requirements
In a May 12 group letter to HHS Secretary Michael Leavitt, the
AAMC and 7 other hospital organizations expressed concern about
the Medicaid documentation requirements established by Section 6036
of the Deficit Reduction Act (P.L.
109-171). Section 6036, effective July 1, requires beneficiaries
to provide specified "documentary evidence" of citizenship
or nationality (e.g. U.S. passport or Certificate of Naturalization).
The letter expresses concern that "significant, unintended
enrollment barriers will exist for millions of low-income citizens"
who can not provide such documents. The letter urges Secretary Leavitt
to use his authority "to allow maximum flexibility in determining
satisfactory documents to verify citizenship" and Medicaid
eligibility. It also advises the Secretary that "validating
Medicaid eligibility is first and foremost the responsibility of
state governments" and "should not be passed along to
hospitals and other providers."
The hospital organizations joining the AAMC in signing the letter
include: American Hospital Association; Catholic Health Association
of the United States; Federation of American Hospitals; National
Association of Children's Hospitals; National Association of Public
Hospitals and Health Systems; Premier; and VHA Inc.
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Pressure Grows on Senate to Consider Stem Cell
Legislation
At a press May 16 event on Capitol Hill, Sen. Orrin Hatch (R-Utah)
released a letter from former First Lady Nancy Reagan calling for
the Senate to take up stem cell legislation. Mrs. Reagan writes,
"For those who are waiting every day for scientific progress
to help their loved ones, the wait for the United States Senate
action has been very difficult and hard to comprehend." May
24 will mark the one-year anniversary of the House passage of "The
Stem Cell Research Enhancement Act" (H.R.
810) which would make additional stem cell lines available to
researchers using federal funds.
At the same press event, the Coalition for the Advancement of Medical
Research released a new poll that revealed nearly three-quarters
of Americans support embryonic stem cell research and want the Senate
to vote on federal funding for stem cell research. When asked if
they support embryonic stem cell research, 72 percent of respondents
favor it, up from 68 percent in 2005. Only 24 percent opposed embryonic
stem cell research, down from 28 percent. When asked, given what
they know about stem cell research, should the Senate vote on H.R.
810, 70 percent of those surveyed said "yes," while only
18 percent said "no" and 12 percent were unsure.
In addition to Sen. Hatch, Sens. Tom Harkin (D-Iowa) and Diane
Feinstein (D-Calif.) also spoke, urging Senate Majority Leader Bill
Frist (R-Tenn.) to schedule a vote on the bill. Sen. Frist announced
his support for the measure last July, but has been unable to reach
a time agreement in order to bring the measure before the full Senate.
AAMC President Jordan Cohen, M.D., May 8 wrote a letter
to Sen. Frist stating, "It is now time for the Senate to vote
on this legislation, which recognizes the need to expand Federal
support of research on pluripotent stem cells so that the tremendous
scientific and medical benefits of their use may one day become
available to the millions of patients who so desperately need them."
Information:
Tony Mazzaschi, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
House Republicans Send Letter Opposing Regulatory
Changes to Medicaid
Reps. Cliff Stearns (R-Fla.), Peter King (R-N.Y.), Dave Reichert
(R-Wash.), and Rob Simmons (R-Conn.) joined 78 of their Republican
colleagues in signing a May 16 Medicaid letter
to HHS Secretary Michael Leavitt. The letter opposes the President's
FY 2007 budget proposals to cut $12.2 billion in Medicaid funding
over 5 years through regulatory changes [see
Washington Highlights, April 7].
Stating that "any savings in the Medicaid program should be
a result of policy discussions with congressional input," the
letter urges Secretary Leavitt to "work with us and other members
of Congress to protect and improve the Medicaid program for our
constituents."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Medicare Occupational Mix Proposed Rule Published
A May 17 proposed
rule published in the Federal Register will modify the Medicare
hospital wage index calculation, effective Oct. 1, so that 100 percent
of an "occupational mix adjustment" will be reflected
in hospitals' wage indices. Currently only 10 percent of the wage
index is adjusted for occupational mix. The wage index adjusts hospitals'
Medicare payments to reflect higher or lower labor costs in their
geographic areas. Required by the Benefits Improvement Act of 2000,
the occupational mix adjustment is intended to ensure that the wage
index calculation reflects only area differences in labor prices,
not the "mix" of hospital employees (for example, hiring
more registered nurses compared to practical nurses.) The May 17
proposed rule replaces the occupational mix information that was
included in the April 25 inpatient PPS proposed rule.
The new proposal stems from a recent court decision (Bellevue Hospital
Center v. Leavitt, April 3, 2006) that requires CMS to move immediately
to a 100 percent adjustment using new data. According to the proposed
rule, CMS is requiring hospitals to submit survey data from Jan.
1, 2006, through March 31, 2006, on employee hours and wages by
June 31 so that it can be used to calculate a new occupational mix
adjustment.
Because of the tight time frame, CMS is concerned that some hospitals
may not submit their survey data. To address this, the proposed rule
seeks comments on 4 options for dealing with non-responding hospitals.
CMS could assign the hospital:
- an occupational mix adjustment factor of 1.0;
- the average occupational mix adjustment factor for its labor market
area;
- the lowest occupational mix adjustment for its labor market area;
or
- the average occupational mix factor for "similar" hospitals
(ex, based on geographic location, teaching status, bed size, case
mix, etc.).
Currently, the first option is used for hospitals that did not
submit survey data in 2003.
CMS states that they are unable to estimate how the new data
will affect the FY 2007 wage index by the time the inpatient rule
must be published (Aug. 1). However, the wage index tables, rates
and impacts will be published before the effective date of Oct.
1, 2006.
Comments on the proposed rule are due on June 12.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
|
