Washington Highlights: April 11,
2008
Contents
Prior Issues
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AAMC Testifies on VA Physician Recruitment and
Retention
On behalf of the AAMC, John A. McDonald, M.D., Ph.D., April 9 testified
at a Senate Committee on Veterans Affairs (VA) hearing
entitled "Making the VA the Workplace of Choice for Health
Care Providers." Dr. McDonald is the Vice President for Health
Sciences and Dean of the University of Nevada School of Medicine
and a member of the AAMC VA-Deans Liaison Committee. In his testimony,
Dr. McDonald stressed the importance of VA's academic affiliations,
graduate medical education, and research opportunities. Committee
members agreed that greater loan repayment for service at the VA
would be a valuable recruitment incentive.
Committee Chair Daniel Akaka (D-Hawaii) noted that Congress had
given VA research a large increase in FY 2008 and thanked Sen. Patty
Murray (D-Wash.) for her work in securing those funds as a member
of the Senate Appropriations Committee. Sen. Akaka also noted that
the VA Committee had recommended an equally large increase for FY
2009. Ranking Member Richard Burr (R-N.C.) lauded the success of
academic affiliations, and stated, "VA's high quality research
can only result from these partnerships."
Jennifer L. Strauss, Ph.D., Assistant Professor in Psychiatry and
Behavioral Sciences, Duke University Medical Center, testified
on behalf of the Friends of VA Medical Care and Health Research
(FOVA) coalition, noting the scarcity of adequate VA research facilities.
The AAMC is a member of the FOVA executive committee.
Information:
Matthew Shick, Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 828-0525
Subcommittee Passes Bill Extending Medicaid Moratorium
The House Energy and Commerce Subcommittee on Health April 9 passed
by voice vote an amendment in the nature of a substitute to the
AAMC-supported "Protecting the Medicaid Safety Net Act of 2008" (H.R.
5613). The substitute was offered by Committee Chair John Dingell
(D-Mich.) and preserves language that would prohibit, until April
1, 2009, any actions by the Centers for Medicare and Medicaid Services
(CMS) related to the Medicaid GME proposed rule, the Medicaid Cost
Limit/Unit of Government ("IGT") final rule, and five
other recently issued Medicaid rules.
According to Chairman Dingell, the substitute represents an "agreement"
with committee Republicans, who believed the original bill language
would prohibit any action to identify and resolve fraud and abuse.
Ranking Subcommittee Member Nathan Deal (R-Ga.) stated that ongoing
investigations by the Government Accountability Office GAO) and
Health and Human Services Inspector General indicate "well-documented"
and "serious" problems in the Medicaid program that require
corrective action.
To address the Republican concerns, the substitute bill would:
- Limit the moratorium to the seven Medicaid regulations identified
by the bill;
- Require by July 1, 2008, a report from the Secretary of Health
and Human Services that justifies each regulation;
- Require by March 1, 2009, an independent study assessing
the state-by-state impact of each regulation; and
- Increase funding for Medicaid fraud and abuse initiatives
by $25 million annually, effective FY 2009.
Following Chairman Dingell's remarks on the substitute, Ranking
Committee Member Joe Barton (R-Texas) expressed "confidence"
that the new language "may" help avert a veto threat from
President Bush. However, the subcommittee could not secure a roll
call vote on the substitute bill, which would have placed Republicans
on record as supporting the moratorium. Rep. Dingell plans a full
committee mark-up of H.R. 5613 during the week of April 14, and
to move "expeditiously" to a vote on the House floor.
The cost of the bill, which is estimated at $1.7 billion, is offset
partially by expanding a Republican-supported asset verification
demonstration program for Medicaid applicants and beneficiaries.
The cost also is offset by a one-time transfer of money from the
Physician Assistance and Quality Improvement (PAQI) Fund in FY 2013.
The PAQI Fund must be replenished the next year.
During the mark-up, Rep. Michael Burgess (R-Texas) urged his colleagues
to consider Medicare-like legislation that establishes federal GME
payments under Medicaid. He warned the subcommittee that Congress
is not doing enough to invest in the training of physicians, and
is ignoring a looming physician shortage. Additional information,
including a webcast of the mark-up is available on the committee
website.
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
MedPAC Passes Primary Care Payment, Medical Home
Recommendations
At its April 9 and 10 meeting,
the Medicare Payment Advisory Commission (MedPAC) continued its
work on promoting the use of primary care by approving recommendations
to increase payments for primary care practitioners and to implement
a pilot program for "medical homes." The commission also
approved a series of recommendations to move toward bundling Medicare
payments for physician and hospital services. Additionally, the
commission discussed public reporting of physician financial interests
and reviewed the Centers for Medicare and Medicaid Services (CMS)
estimate for the physician payment update for 2009. The recommendations
and comments will appear in MedPAC's annual June Report to Congress.
In the first of two recommendations regarding primary care, the
commission passed a recommendation to include a payment adjustment
for services provided by "primary care-focused practitioners."
The adjustment would be budget neutral; that is, it would be paid
for by reducing payments for other physician services. The recommendation
states that CMS will establish criteria for determining primary
care-focused practitioners. Two commissioners, Karen R. Borman,
M.D., and William J. Scanlon, Ph.D., voted against this recommendation,
noting that it only would change the workforce by increasing the
number of primary care physicians, but would not change the delivery
system to increase coordination of care or to decrease the volume
of services.
In a second primary care-focused recommendation, MedPAC unanimously
recommended that Congress initiate a "medical home" pilot
project. According to MedPAC, the purpose of a medical home entity
would be to increase care coordination, including enhanced primary
care, and improve care efficiency. Such an entity must be capable
of furnishing primary care, conducting care management, using information
technology for clinical decision support, and must have a formal
quality program. MedPAC envisions the medical home would receive
a monthly per beneficiary payment for medical home infrastructure
and activities, and could still continue to bill separately for
practitioner services. The recommendation also states that Medicare
should provide timely data to the medical homes and that some type
of pay-for-performance program also should be integrated in the
pilot.
In an attempt to better align incentives around hospital services,
MedPAC endorsed a series of recommendations on bundled payments
for hospitals and physicians for services around a hospitalization.
The first recommendation is for CMS to report confidentially resource
use to both hospitals and physicians around select hospitalizations
for two years. Public reporting would begin in the third year. The
second recommendation provides an interim step toward bundled payments,
stating that CMS should reduce payments for hospitals with relatively
high readmission rates and allow for "shared accountability"
(also referred to as gainsharing) between physicians and hospitals
to encourage collaboration and better coordination of care. In addition,
the Secretary should report within two years the feasibility of
broader approaches, such as virtual bundling, for "encouraging
effectiveness" around a hospitalization. In the final recommendation,
CMS should set up a voluntary pilot to test the feasibility of implementing
an actual bundled payment system for hospital and physician services
around a hospitalization.
MedPAC continued its review of publicly reporting physicians' financial
relationships with manufacturers, hospitals, and ambulatory surgical
centers (ASCs). No recommendations were made, but a chapter on this
topic will appear in the June report. MedPAC also indicated that
it would continue working on this topic in the fall.
As mandated by law, MedPAC staff presented an overview of CMS's
estimate for the physician services for 2009. CMS estimates the
2009 update to be negative 5.4 percent.
Other items discussed at the MedPAC meeting include:
- Revised prospective payment system for skilled nursing facilities;
- Employer group Medicare Advantage plans;
- Producing comparative-effectiveness information;
- Accountable care organizations;
- Consumer education campaigns; and
- Content and quality of hospice care.
Information:
Diana Mayes, Staff Associate
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
Mary Patton, Senior Policy Analyst
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Senators Urge Title VII Restoration
A total of 49 Senators signed an April 4 letter
that urges restored funding of the Title VII health professions
programs to the FY 2005 level of $300 million. Senators Jack Reed
(D-R.I.) and Pat Roberts (R-Kan.) organized the letter, addressed
to Labor, Health and Human Services, and Education Appropriations
Subcommittee Chair Tom Harkin (D-Iowa) and Ranking Member Arlen
Specter (R-Pa.). The letter notes that "dramatically reduced
funding" levels for the programs have had a "devastating
effect on the country's neediest communities." Representatives
Diana DeGette (D-Colo.) and Cathy McMorris Rodgers led a March 14
companion letter in the House, which gathered 131 signatures [see
Washington
Highlights,
March 21].
Information:
Tannaz Rasouli, Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
IRS Releases Draft Instructions, Worksheets for
Schedule H
The Internal Revenue Service (IRS) April 7 released
the draft Form 990 instructions, including draft instructions and
worksheets for Schedule H [see Washington
Highlights,
Jan. 18]. Hospitals, defined by the IRS as "a facility
that is, or is required to be, licensed or certified in its state
as a hospital," use Schedule H to report charity care and other
community benefits. For the 2008 tax filing year, hospitals only
are required to complete Part V, Facility Information, of Schedule
H. All other parts will be required for 2009.
The IRS is inviting comments from the public through June 1, 2008,
and intends to publish final instructions and worksheets at the
end of 2008.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
NIH Center for Research Resources Posts Strategic
Plan
The National Institutes of Health (NIH)'s National Center for Research
Resources (NCRR) April 8 posted its draft
strategic plan for 2009-2013 and seeks public comment. The NCRR
supports major programs for development of shared infrastructure
and vital national resources, including primate and other animal
facilities, instrumentation and biotechnology centers, research
at minority institutions, regional centers of excellence, and clinical
research resources such as the Clinical and Translational Science
Awards (CTSA, initiated under the NIH Roadmap). In her message
welcoming public comments, NCRR Director Barbara Alving, M.D., said
that NCRR also would be developing an implementation progress report
in the coming weeks. The deadline for public comments is April 23.
Information:
Irena Tartokovsky, Clinical Research Program Manager
AAMC Biomedical and Health Sciences Research
itartakovsky@aamc.org
(202) 862-6134
On the Hill...
Former state lawmaker Jackie Speier (D-Calif.) April 10 was sworn
in to the U.S. House of Representatives. Rep. Speier succeeds Rep.
Tom Lantos (D), who succumbed to esophageal cancer earlier this
year.
Rep. Albert Wynn (D-Md.) April 9 resigned from the House Committee
on Energy and Commerce, two months before his resignation from the
House is scheduled to take effect. In February, challenger Donna
Edwards defeated Rep. Wynn in Maryland's Democratic primary.
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