Washington Highlights: November
17, 2006
Contents
Prior Issues
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AAMC Signs Letter Urging Immediate Physician Payment
Fix
The AAMC, with 127 physician organizations, Nov. 13 sent letters
to Senate Majority Leader Bill Frist (Tenn.) and House Speaker Dennis
Hastert (Ill.), urging passage of a Medicare physician payment fix
during the lame-duck session. Copies of the letters were sent to
all members of Congress. Highlighting the fact that over 265 House
members and 80 Senators have called for a positive payment update
in CY 2007, the letter strongly urges Congress "to take immediate
action."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Congress Extends Stopgap Funding
On Nov. 15, both the House and Senate passed by voice vote H.J.Res.
100, a continuing resolution (CR) to provide funding through Dec.
8 for government agencies whose FY 2007 spending bills have not
yet been enacted. To date, only two of the 12 regular spending bills
- Defense and Homeland Security - have been signed into law. For
programs in the Labor-HHS-Education bill (H.R. 5647/S. 3708), the
CR provides funds at the FY 2006 level. This is the second CR for
the fiscal year; the current CR expires Nov. 17 [see Washington
Highlights, Oct. 6].
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Congress Clears Animal Research Protection Act
The House Nov. 13 approved the Animal Enterprise Terrorism Act
(S.
3880), which was passed by the Senate Sept. 30 [see Washington
Highlights, Oct. 6]. The
President is expected to sign the legislation.
Co-sponsored by Sens. James Inhofe (R-Okla.) and Dianne Feinstein
(D-Calif.), the bill extends existing protections for animal research
enterprises to individuals, businesses and agencies, such as scientists,
biomedical and biotechnology industries, research universities,
teaching hospitals, financial institutions and others who have associations
with animal research. AETA calls for fines and/or imprisonment of
animal rights advocates who threaten scientists conducting animal
research or companies funding or affiliated with the research.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
MedPAC IME and DSH Discussions Begin to Focus
After what arguably could be considered "preliminary"
discussions at the September and October meetings, the Medicare
Payment Advisory Commission (MedPAC) at its Nov. 8 meeting
appeared to be starting to coalesce around certain themes regarding
Medicare indirect medical education (IME) and disproportionate share
(DSH) hospital payments.
As in previous meetings, staff presented data on Medicare hospital
margins, noting that such margins at major teaching hospitals are
significantly higher than those at other hospitals. A growing number
of commissioners urged staff to show Medicare margins that do not
include DSH payments since these payments are largely intended to
offset costs for uninsured patients, while Medicare margins only
reflect costs associated with Medicare patients.
Recognizing that one role of the IME adjustment is to offset teaching
hospitals' higher patient care costs associated with treating more
severe and complex patients, most commissioners agreed that any
IME reduction should be coupled with improving the severity adjustment
in the current inpatient payment system.
MedPAC Chair Glenn Hackbarth attempted to summarize the discussions
to date by reiterating his support for implementing severity adjustments.
In terms of IME payments above the so-called "empirical"
amount [see Washington Highlights,
Oct. 13], he noted several savings options for reducing the
IME adjustments: a) put them into base DRG payments for distribution
across all hospitals, b) include them in a pay-for-performance pool
for all hospitals, and c) use the savings to encourage teaching
hospitals to change how medical students and residents are educated
and the specialties they enter.
While there was no explicit consensus around the options, it appeared
the commission was moving toward including a chapter in the March
report that would discuss the IME adjustment, including the savings
options, but would not vote on any specific recommendations.
On the Medicare DSH front, commissioners appeared prepared to recommend
that CMS collect data on uncompensated care, as previously recommended.
The commission also appeared to be reaching consensus that the current
DSH distribution formula should be reviewed with the intent of better
directing DSH payments to hospitals providing the most uncompensated
care.
The commission also spent considerable time discussing Medicare
physician issues (see related article). Other topics presented at
the meeting included:
- Mandated report on rural hospital payment changes;
- Update on Medicare private plans; and
- Results of site visits to hospital-based skilled nursing facilities.
MedPAC's next meeting will be held Dec. 7-8.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
MedPAC Continues SGR Alternatives Discussion
Advisory Commission (MedPAC) continued its work on a mandated report
to evaluate alternatives to the sustainable growth rate (SGR) for
updating physician payments [see Washington
Highlights, Oct. 13].
The MedPAC report will address volume control at the medical group
level, physician outliers, and hospital medical staff.
Elliott Fisher, M.D., M.P.H., Dartmouth Center for Evaluative Clinical
Services, presented a potential approach for evaluating hospital
medical staff. Using the term "extended hospital medical staff"
(EHMS), Dr. Fisher suggested that physician measurement and volume
controls could be applied to all physicians, even physicians that
do not admit patients to a specific hospital. Physicians with inpatient
work would be assigned to the hospital where most of their inpatient
work was performed. Physicians that do not have inpatient work would
be assigned to the hospital where the plurality of the patients
they billed for were admitted. Almost all Medicare physicians could
be assigned to an acute care hospital using this methodology.
Medicare beneficiaries also would be assigned to their primary
EHMS, and the EHMS could be held accountable for care delivered.
Dr. Fisher noted that based on his work at Dartmouth Atlas, he believes
unnecessary variation is due to excess supply, and this proposal
will inform decisions on increasing capacity.
The commissioners expressed interest in the EHMS model and discussed
issues that could impact implementation, such as measuring care
for beneficiaries who live in different hospital regions throughout
the year; incorporating care from other organizations such as skilled
nursing facilities; and measuring services and care provided by
referral hospitals.
MedPAC staff also presented preliminary results of the episode
treatment groupers that measure and compare care provided by multi-specialty
groups and identify physician outliers. The report is due to Congress
March 1, 2007.
Information:
Denise Dodero, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Senate Passes FY 2007 VA Appropriations
The Senate Nov. 14 passed (95-1) its version of the Military Construction
and Veterans Affairs Appropriations Bill (H.R.
5385, S. Rept. 109-286). Sen. George Allen (R-Va.) was the lone
dissenting vote. The Senate bill provides $412 million for VA Medical
and Prosthetic Research, matching the House passed level.
$15 million of these funds is earmarked as the second installment
of a 5-year commitment to Gulf War Illness Research at the University
of Texas Southwestern Medical Center at Dallas. The Senate's Minor
Construction appropriation does not include the additional $12 million
for research facilities that was approved by the House in May [see
Washington Highlights,
May 26].
The Senate bill provides $32.258 billion for VA medical care, a
$3.555 billion (12.4 percent) increase over the FY 2006 levels and
the same as the President's request for FY 2007. It is unclear if
Congress will be able to conference and pass a compromise bill before
it adjourns.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Democrats Select New Leaders
Senate Democrats met Nov. 14 to decide their leadership positions
for the 110th Congress. It was announced that Sen. Robert C. Byrd
(W.Va.) will be the President Pro Temp of the Senate.
As expected, Democrats selected Sen. Harry Reid (Nev.) to serve
as Majority Leader and Sen. Dick Durbin (Ill.) as Assistant Majority
Leader.
Reid created a special leadership position - Conference Vice Chair
- to reward Sen. Charles Schumer (N.Y) for his service as Chair
of the Democratic Senatorial Campaign Committee (DSCC). Schumer,
who now ranks third in the Democratic leadership, will continue
to chair the DSCC.
Senate Democrats elected Sen. Patty Murray (Wash.) to replace Sen.
Debbie Stabenow (Mich.) as Democratic Conference Secretary. This
position, previously third in the Democratic leadership, will now
rank fourth.
Reid appointed Sen. Byron L. Dorgan (N.D.) for another term as
Chair of the Democratic Policy Committee.
Reid also appointed Stabenow as Chair of the Steering and Outreach
Committee, where she replaces Sen. Hillary Rodham Clinton (N.Y.).
Clinton assumes the position as Vice Chair of Committee Outreach,
where she will work with Sen. Jeff Bingaman (N.Mex.) who will chair
Committee Outreach.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
House Democrats Elect Hoyer Majority Leader
House Democrats Nov. 16 voted to elect Rep. Steny Hoyer (Md.) as
House Majority Leader for the 110th Congress. Hoyer defeated Rep.
John Murtha (Pa.) by a vote of 149-86 for the number two leadership
position behind incoming Speaker of the House Nancy Pelosi (Calif.).
Democrats also selected Rep. James Clyburn (S.C.) as Majority Whip,
the number three position in the leadership. Rep. Rahm Emanuel (Ill.),
who served as House Democratic campaign chair, was rewarded with
the caucus chairmanship, the number four position for Democrats.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
GOP Senators Tap Lott For Number 2 Slot
Senate Republicans Nov. 15 elected Sen. Trent Lott (Miss.) to be
Minority Whip in the 110th Congress. Lott reportedly defeated Sen.
Lamar Alexander (Tenn.) by a single vote. Lott was removed from
the top Senate Republican leadership job four years ago because
of remarks considered racially insensitive.
Lott will be the GOP's second-in-command to Sen. Mitch McConnell
(Ky.), who was elected unanimously to be the Senate minority leader
in the new Congress. Senate Republicans also elected Sen. Jon Kyl
(Ariz.) as GOP Conference Chair; Sen. Kay Bailey Hutchison (Texas)
as Policy Committee Chair; Sen. John Cornyn (Texas) as GOP Conference
Vice Chair; and Sen. John Ensign (Nevada) to chair the Republican
Senatorial Committee.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AHRQ Announces Safety Simulator Grants
The Agency for Healthcare Research and Quality (AHRQ) Nov. 14 announced
it has awarded more than $5 million for 19 new grants under its
"Improving Patient Safety Through Simulation Research"
portfolio. The projects
focus on assessing and evaluating the roles that simulation can
play to improve the safe delivery of quality health care.
Medical simulation re-creates actual medical situations so health
care providers can practice new procedures and techniques before
performing them on patients. These projects will inform providers,
health educators, payers, policy makers, patients, and the public
about the effective use of simulation in preventing medical errors
and improving patient safety.
AHRQ awarded grants to the following institutions:
- The Children's Hospital of Philadelphia;
- Cincinnati Children's Hospital and Medical Center;
- Duke University;
- Evanston Northwestern Healthcare;
- Louisiana State University Health Sciences Center;
- Oregon Health and Science University;
- Scott and White Hospital (Texas);
- Stanford University;
- Washington University School of Medicine;
- Yale University;
- University at Buffalo-The State University of New York;
- University of Alabama-Birmingham;
- University of Chicago;
- University of Colorado at Denver & Health Sciences Center;
- University of Minnesota;
- University of Pittsburgh; and
- University of Washington.
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