Washington Highlights: December
8, 2006
Contents
Prior Issues
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AAMC and Hospital Groups Urge Congress to Prevent
Medicaid Cuts
AAMC President Darrell Kirch, M.D., American Hospital Association
Executive Vice President Rick Pollack, and National Association
of Public Hospitals and Health Systems President Larry Gage co-signed
a Dec. 4 letter
to current and incoming congressional leaders expressing "concern
with the administration's plan to cut the Medicaid program through
the regulatory process." The letter warns that "the administration
plans to move forward" and cut $12.2 billion in FY 2007 Medicaid
funding [see Washington Highlights,
Feb. 10]. It urges the members to "prevent CMS from proceeding
with the implementation of these rules."
In the Senate, the letter was sent to: Majority Leader Bill Frist
(R-Tenn.); incoming Majority Leader Harry Reid (D-Nev.); incoming
Assistant Majority Leader Dick Durbin (D-Ill.); incoming Minority
Leader Mitch McConnell (R-Ky.); Finance Committee Chairman Charles
Grassley (R-Iowa); and incoming Finance Committee Chairman Max Baucus
(D-Mont.). In the House, the letter was delivered to: Speaker Dennis
Hastert (R-Ill.); incoming Speaker Nancy Pelosi (D-Calif.); House
Majority Leader John Boehner (R-Ohio); incoming House Majority Leader
Steny Hoyer (D-Md.); House Majority Whip Roy Blunt (R-Mo.); Energy
and Commerce Committee Chairman Joe Barton (R-Texas); and incoming
Energy and Commerce Committee Chairman John Dingell (D-Mich.).
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Congress to Pass Third Funding Extension
The House and Senate must approve a third stopgap funding measure
before they adjourn for the end of the 109th Congress. Both chambers
are expected to pass a continuing resolution (CR) to keep federal
programs running through Feb. 15, 2007.
Congress must pass another CR to provide funds for federal programs
in the nine FY 2007 spending bills that have not-yet been enacted.
These programs are currently funded under a CR that expires Dec.
8. The CR includes the Labor-HHS-Education bill (H.R.
5647, S.
3708). Programs in the Labor-HHS-Education bill will continue
to be funded at the FY 2006 level.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC, HPNEC Urge Title VII Restoration
The AAMC, along with 60 national health and education organizations,
Dec. 6 urged Congress to restore funding for the Title VII health
professions programs to FY 2005 levels. The Health Professions and
Nursing Education Coalition (HPNEC) letter,
sent to all Members of Congress, states, "it is essential that
Congress reverse the enacted cuts to the health professions programs
to help resolve systemic workforce shortages and deliver care to
our nation's most vulnerable communities."
The final appropriation for FY 2006 cut funding for Title VII programs
by 51.5 percent, resulting in the elimination or drastic reduction
of grant programs including the Health Careers Opportunity Program,
Centers of Excellence, primary care training, geriatric education,
and rural training. Neither the House nor Senate Labor-HHS-Education
Appropriations bills for FY 2007 (HR 5647, S 3708) fully restore
funding for the health professions programs. With expected passage
of another continuing resolution to Feb. 15, 2007, the programs
will continue to be funded at FY 2006 levels until the FY 2007 budget
is finalized (see related story).
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Senate May Consider NIH Bill
At press time, it is unclear whether the Senate will take up a
revised National Institutes of Health (NIH) reauthorization bill
that resulted from extensive negotiations between House Energy and
Commerce Chair Joe Barton (R-Texas) and members of the Senate appropriations
and authorizing committees. Senator Mike Enzi (R-Wyo.), chair of
the Health, Education, Labor and Pensions Committee reportedly "hotlined"
the bill Dec. 6, relinquishing his committee's jurisdiction over
the legislation and making it eligible for Senate approval.
The revised bill increases the authorization levels for NIH to
$30.3 billion in FY 2007 and $32.8 billion in FY 2008, which represent
increases of 7 percent and 8.2 percent respectively. The bill also
authorizes "such sums as may be necessary" for FY 2009.
The House passed bill authorized 5 percent increases each year for
FYs 2007 through 2009, peaking at $32.8 billion in FY 2009.
The revised bill also eliminates the formula included in the House
passed bill to direct half of all new dollars for NIH to the "common
fund." The new bill requires the Director of NIH to establish
a reserve account to fund the common fund, subject to appropriations.
The revised bill also clarifies that the amount reserved for the
common fund may not be less than the percentage reserved during
the previous fiscal year and requires a report to Congress every
two years, beginning June 1, 2007, outlining the strategic plan
for funding research through the common fund.
The new bill also clarifies that certain recommendations regarding
the organizational structure of the NIH made by the Scientific Management
Review Board are subject to congressional review prior to implementation.
The House passed the "National Institutes of Health Reform
Act of 2006" (H.R.
6164) Sept. 26 [see Washington
Highlights, Sept. 29].
The House is expected to approve the revised bill before it adjourns,
clearing the measure for the President.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
VA Plans to Increase GME Positions
The Department of Veterans Affairs (VA) plans to increase support
for medical residency positions starting in the 2007-2008 academic
year (AY). The graduate medical education (GME) enhancement initiative
stems from the recommendations included in the September 2005 Advisory
Committee on Veterans Health Administration Resident Education report.
The report encouraged the VA to restore and maintain its historic
support for 11 percent of the total U.S. resident physician positions.
In recent years, the VA has averaged only 9 percent of the national
total.
VA anticipates adding 2000 resident positions over the next 5 years
at a rate of 300 to 500 positions annually. The VA reports that
it has approved funding for Phase I (AY 2007-08) and approved initiation
of Phase II (AY 2008-09). In the first round of the GME enhancement
initiative, 341 new positions will be added across the country in
July 2007. The next request for proposals will be issued in spring
2008.
According to Malcolm Cox, M.D., VA Chief Academic Affiliations
Officer, "These positions will not only address VA's critical
needs and the looming U.S. physician workforce shortage, but will
also provide flexibility in training in new specialties and new
sites of care, such as community-based clinics. The availability
of additional physician resident positions will also encourage innovation
in education that is patient-centered and inter-professional in
nature and that incorporates state-of-the-art models of clinical
care, including VA's renowned quality and patient safety programs
and electronic medical record system."
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Clears Biodefense Bill
The Senate Dec. 5 passed the Pandemic and All-Hazards Preparedness
Act (S.
3678). The bill creates the Biomedical Advanced Research and
Development Authority (BARDA) within the Department of Health and
Human Services (HHS). BARDA is designed to improve upon Project
Bioshield by coordinating all federal research and development of
bioterrorism countermeasures. It also reauthorizes the existing
bioterrorism law (P.L.
107-188).
S. 3678 also returns the National Disaster Medical System (NDMS)
to HHS from the Department of Homeland Security and includes an
EMTALA waiver, which allows for the transfer of individuals from
hospitals during an emergency involving a pandemic infectious disease.
The bill also creates partnerships for state and regional hospital
preparedness to improve surge capacity and allows the HHS Secretary
to reserve an amount from the existing Bioterrorism Hospital Preparedness
program for these partnerships.
The House Sept. 26 passed a biodefense bill (H.R.
5533) that includes the creation of BARDA but not the reauthorization
provisions [see Washington Highlights,
Sept. 29]. Additionally, the Senate bill authorizes $1.1 billion
for advanced research and development over fiscal years 2007 and
2008, while the House bill authorizes $320 million over those years.
It is unclear if the House will pass S. 3678 before it adjourns.
Information:
Erica Froyd, Director, Public Health and Research Legislative Affairs
AAMC Government Relations
efroyd@aamc.org
(202) 828-0525
House Extends Physician Visa Waivers
The House Dec. 6 passed the "Physicians for Underserved Areas
Act" (H.R.
4997) to reauthorize J-1 visa waiver programs through 2008.
These waiver programs exempt foreign physicians who receive their
graduate medical education in the U.S. from the 2-year home service
requirement of the J-1 visa in exchange for practicing in a health
professions shortage area. Participating entities include the Department
of Health and Human Services, the Mississippi Delta Regional Authority,
the Appalachian Regional Commission, and the State Departments of
Health "Conrad 30" program.
Corresponding legislation (S.
2425) was introduced March 15 by Sens. Kent Conrad (D.-N.D.)
and Sam Brownback (R-Kan.). The senators are pushing for a vote
on H.R. 4997 before Congress adjourns.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Passes Ryan White
After weeks of being stalled by New York and New Jersey lawmakers,
the Senate Dec. 6 passed by voice vote a bill (H.R.
6143) to reauthorize the Ryan White CARE Act (P.L.
106-345). Sens. Hillary Clinton (D-N.Y.), Charles Schumer (D-N.Y.),
Frank Lautenberg (D-N.J.) and Robert Menendez (D-N.J.) lifted their
block on the measure after ranking member of the Senate Health,
Education, Labor and Pensions Committee Sen. Edward Kennedy (D-Mass.)
negotiated a compromise to mitigate the expected funding losses
to urban states.
Under the compromise, the program will be reauthorized for 3 years
instead of 5, as originally intended in the House-passed bill. Additionally,
the law will be completely repealed in 3 years, requiring a new
law to be written in accordance with a comprehensive reevaluation
of the program's structure. The amended bill also includes a provision
that maintains funds for Title I and Title II at a minimum of 95
percent of the FY 2006 levels for each state.
The House Sept. 26 passed its version of the bill, but it is unclear
whether the House will consider the amended bill before adjournment
[see Washington Highlights,
Sept. 29].
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
JCAHO Releases Patient Level Data Collection Policy
The Joint Commission on Accreditation of Health Care Organizations
(JCAHO) Nov. 27 released its new patient level data collection policy.
The new policy is aimed at improving the validity and reliability
of the data collected through its core measure program, which is
the same process that collects the data submitted to the Centers
for Medicare and Medicaid Services (CMS) for the hospital pay for
reporting program. Prior to the release, JCAHO held eight months
of meetings with hospitals across the country to address concerns
raised when the proposal was announced earlier this year.
Previously, JCAHO received aggregate hospital data including a
random sample of patient level data for 20 percent of the relevant
cases for each measure. Beginning with second quarter 2007 discharges,
JCAHO will continue to receive the aggregate hospital data but also
will receive a 100 percent patient sample for the relevant cases
for each performance measure. This first set of data is due to be
reported by Oct. 31, 2007.
The data will not contain any hospital specific identifiers or
any patient specific identifiers such as name or Social Security
number. The patient specific data will remain in the possession
of the vendors, who will be responsible for stripping the data and
providing a file to the JCAHO that only contains a randomly generated
identifier for tracking purposes in case there are data inconsistencies.
By collecting the patient level data, JCAHO will be in a better
position to audit the data consistently and identify any inconsistencies
that could affect a hospital's performance rating.
The new policy will not change the way the hospitals submit data
to their vendor and should be a seamless change. However, vendors
may look to charge hospitals a small one-time fee to accommodate
the new submission requirements.
Information:
Jennifer Faerberg, AAMC Division of Health Care Affairs
Director, GME Track/Health Care Quality Liaison
jfaerberg@aamc.org
(202) 862-6221
NIH Director Discusses "Post-Doubling" Era
National Institutes of Health (NIH) Director Elias Zerhouni, M.D.,
Dec. 1 presented his analysis of the fiscal and programmatic constraints
faced by the agency nearly four years after completion of the agency's
budget doubling at a meeting
of the Advisory Committee to the Director (ACD). Dr. Zerhouni's
analysis, published in the Nov.
16 issue of Science, resumes the ACD's deliberations on this
topic begun at the June 2 meeting [see Washington
Highlights, June 9].
Dr. Zerhouni noted that the limited growth in NIH appropriations
since 2003, the effects of inflation, a continuing increase in numbers
of new applications, and a backlog of prior commitments have combined
to make the current funding environment extremely difficult for
scientists seeking funding for their research proposals. He reported
that overall success rates for award of NIH research project grants
are about 20 percent, and 17 percent for new applications.
ACD member Tadataka Yamada, M.D., newly appointed President of
the Gates Foundation Global Health Program, described the issue
as a "supply-demand" problem, and suggested that NIH ask
the National Academies to help develop a plan for better balancing
the supply of scientists with foreseeable resources. Committee member
David Botstein, Ph.D., of Princeton University criticized universities'
over-expansion of infrastructure, based on unrealistic expectations
for NIH to finance the new capacity. Karen Holbrook, Ph.D., President
of Ohio State University and a new member to the ACD, defended the
"deans'" decisions as necessary to modernize outdated
facilities and meet the technological requirements of cutting-edge
science.
The ACD was particularly concerned that fewer than 10 percent of
un-amended R01 applications are funded on their first try, and suggested
ways NIH might shorten the cycle leading to first award. In later
discussions, the committee strongly endorsed efforts to streamline
or simplify regulations on investigators and institutions, which
they note create a significant burden on institutional resources.
NIH's plans to switch to electronic grant submission for most major
award mechanisms in February initiated much discussion. The ACD
remains concerned that investigators are not fully briefed about
new procedures, and urged NIH to communicate more information clarifying
the e-application requirements to help institutions better prepare
for the switch. The NIH leadership noted that the change is required
by federal mandate, but agreed to work for better communication.
Dr. Zerhouni also proposed creation of a "users group"
of ACD members to identify early problems in electronic submission.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
CMS Updates PPAC on Quality Reporting, Cost Measurement
At the Dec. 4 meeting
of Physician Payment Advisory Commission (PPAC), Tom Valuck, M.D.,
J.D., of the Centers of Medicare and Medicaid Services (CMS), presented
an update on the agency's initiatives on quality reporting and cost
measurement. CMS is distributing the first set of confidential performance
reports to physicians participating in the Physician Voluntary Reporting
Program (PVRP). The PVRP
is a voluntary program where physicians report quality indicators
through adding special codes to Medicare claims. CMS plans to expand
it in 2007 from the current 16 measures to 66 measures.
CMS also is working with its contractor to evaluate the feasibility
of a commercial episode grouper regarding cost and efficiency measures.
CMS's goal is to "develop meaningful, actionable, and fair"
cost measurements and to link those measurements to quality.
In addition, CMS presented the 2006 findings
of the initial Medicare Contractor Provider Satisfaction Survey.
The average composite score for carriers was 4.52 on a 6-point scale.
The most important predictors of satisfaction were the handling
of inquiries and claims. The 2007 survey will run from January through
April, and will add new satisfaction metrics and questions on the
National Provider Identifier (NPI).
Other topics addressed in the meeting include:
- Updates on Physicians Regulatory Issues Team (PRIT) activities;
- 2006 findings of the Recovery Audit Contractors (RAC) demonstration;
and
- Highlights of the 2007 physician fee schedule and other payment
systems.
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 Confirms FDA Head
The Senate Dec. 7 voted 80-11 to confirm Andrew C. von Eschenbach,
M.D. as commissioner of the Food and Drug Administration (FDA).
Originally nominated for the position in March, von Eschenbach has
been serving as acting commissioner since September 2005. For part
of that time, von Eschenbach also led the National Cancer Institute
(NCI) where he was director since January 2002, until leaving to
head the FDA full time in June. The president appointed John E.
Niederhuber, M.D., director of NCI in August [see Washington
Highlights, Sept. 1].
Prior to his appointment at NCI, von Eschenbach was Executive Vice
President and Chief Academic Officer of the University of Texas
M.D. Anderson Cancer Center in Houston, where he also served as
Vice President for Academic Affairs and held the Roy M. and Phyllis
Gough Huffington Clinical Research Distinguished Chair in Urologic
Oncology.
A graduate of St. Joseph's University in Philadelphia, von Eschenbach
received his medical degree from Georgetown University School of
Medicine. He completed internship at Philadelphia General Hospital
and residency in urologic surgery at Pennsylvania Hospital in Philadelphia
before serving as an instructor in urology at the University of
Pennsylvania School of Medicine.
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