Washington Highlights: June 13,
2008
Senate Attempts to Take Up Medicare Package
Contents
Prior Issues
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Senate Finance Committee Chair Max Baucus
(D-Mont.) June 12 fell short of securing the 60 votes needed to
block a filibuster of his much anticipated Medicare package. Chairman
Baucus reportedly will rework portions of the "Medicare Improvements
for Patients and Providers Act of 2008" (S. 3101) before a
second vote is scheduled.
The bill would have extended the current Medicare physician payment
update (0.5 percent) through Dec. 31. Without Congressional action,
the conversion factor used to calculate Medicare physician payments
will be reduced by 10.6 percent on July 1. The package also established
a 1.1 percent payment update for Calendar Year (CY) 2009 and extended
by 2 years the current Physician Quality Reporting Initiative (PQRI).
PQRI participants would receive a 2 percent bonus payment for reporting
measures in CY 2009 and CY 2010. According to the Congressional
Budget Office (CBO), the payment relief and quality reporting
payments will cost a combined $6.8 billion over 5 years.
The Baucus bill identified partial offsets for the cost of the
measure, which also addressed rural providers and Medicare Advantage
plans. The bill included a $1.3 billion cut (over 5 years) to the
Medicare Advantage Stabilization Fund and phased out the Indirect
Medical Education (IME) component contained in the calculation that
determines payments to the plans (a savings of $12.5 billion over
5 years). Such a proposal does not contradict AAMC policy to preserve
the IME payments made by Medicare directly to teaching hospitals
for treating Medicare Advantage beneficiaries. Chairman Baucus's
bill also called for an IOM report on "best practices"
for reviewing "clinical effectiveness research and for developing
clinical protocols."
Ranking Member Charles Grassley
(R-Iowa) has introduced alternative Medicare legislation, which
likely will be a factor as Baucus revisits his bill. While portions
of the Grassley bill are similar to those in S. 3130, (e.g., physician
payment relief, reductions in Medicare Advantage spending), Grassley's
bill would "introduce the principles" of value-based purchasing
to Medicare-beginning with hospitals. The bill also would apply
the current Medicare payment reductions for "certain hospital-acquired
conditions" to inpatient Medicaid services.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
House Subcommittees Begin Drafting Spending Bills
Having agreed to a spending plan for the coming fiscal year, Congress
has begun work on the 12 annual appropriations bills that will implement
that plan. House Appropriations Subcommittees began considering
their FY 2009 spending bills this week, and the Senate Appropriations
Subcommittees are expected to begin their
work later this month.
The House Appropriations Subcommittee on Military Construction
and Veterans Affairs June 12 approved its draft spending bill. A
statement
by Subcommittee Chair Chet Edwards (D-Texas) indicates that the
bill includes "$58 million to restore the cut taken by the
Department for medical research in trauma, mental health and other
areas that are critical to finding the best treatments for our OEF/OIF
veterans, and to increase funding for research in areas that are
most important to the veteran population." The VA spending
bill also includes "an additional $136 million for medical
facilities," but it is unclear if any of these funds will be
designated for research facilities improvements. The full Appropriations
Committee is scheduled to consider the bill June 19.
According to press reports, House Appropriations Committee Chair
David R. Obey (D-Wis.) said that "one area where we are still
grossly behind the curve is research" and that "this bill
attempts to make a significant increase in that area."
The President's budget request for FY 2009 includes $442 million
for the VA Medical and Prosthetic Research program, a $38 million
(7.9 percent) decrease from FY 2008. The Friends of VA Medical Care
and Health Research (FOVA) recommend
$555 million for VA research and an additional $45 million for research
facility improvements. The AAMC is a member of the FOVA executive
committee.
Also on June 12, the House Commerce-Justice-Science (CJS) Subcommittee
approved by voice vote its FY 2009 draft spending bill, reportedly
providing $6.9 billion for the National Science Foundation (NSF).
The funding level represents an $830 million increase (13.6 percent)
over the FY 2008 level. The President's budget had requested $6.85
billion for NSF.
In his opening
statement, CJS Subcommittee Chair Alan Mollohan (D-W.Va.) highlighted
the bill's investment in science and noted that "significant
investments in this area and in science, math and engineering education
are critical if this country is to remain competitive in today's
global economy." The full Appropriations Committee is scheduled
to consider the bill June 19.
The House Labor-HHS-Education Subcommittee is scheduled to mark
up its bill on June 19, with full committee action on June 25. The
Senate Labor-HHS-Education Subcommittee is scheduled to consider
its bill the week of June 23.
If and when any of these bills will go to the House floor is uncertain
at present as Democratic leaders are still pondering their options
in the face of repeated veto threats from the White House. The Congressional
budget drafted by the Democrats proposes to spend about $21 billion
more in FY 2009 than requested by the President.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
NIH Acts to Implement Enhanced Peer Review
Two working groups of the National Institutes of Health (NIH) have
completed their year-long examination of current NIH peer-review
processes. Lawrence Tabak, DDS, Ph.D., Director of the National
Institute of Dental and Craniofacial Research, and Jeremy Berg,
Ph.D., Director of the National Institute of General Medical Sciences,
June 6 presented
the implementation plan for enhanced peer review at the meeting
of the NIH's Advisory Committee to the Director (ACD).
Given that the plan responds to comments submitted previously by
the research community, NIH announced that it would begin to implement
the recommendations, which address four major priorities:
- Engage the Best Reviewers by increasing flexibility of service,
formally acknowledging reviewer efforts, better compensating time
and effort, and enhancing and standardizing training. The implementation
plan proposes to allow reviewers who serve for a minimum of 18
full study section meetings to apply for an administrative supplement
of up to $250,000 or to be considered for the agency's distinguished
MERIT or Javits awards.
- Improve Quality and Transparency of Reviews. Shorten and redesign
applications to highlight impact and to allow alignment of the
application, review and summary statement with 5 explicit review
criteria, and modify the rating system. The new R01 application
will be 12 pages, with an optional 8-page appendix.
- Ensure Balanced and Fair Reviews Across Scientific Fields and
Career Stages. The plan proposes to fund within the NIH Roadmap
a minimum number of early stage investigators and investigators
new to NIH by creating an investigator-initiated "Transformative
R01 Award" program with an intended minimum commitment of
$250 million over 5 years. The plan also suggests investing at
least $750 million in the Pioneer, EUREKA, and New Innovator Awards
programs over the next 5 years.
- Continuously Review Peer Review. The plan proposes that NIH
develop a permanent process to continuously evaluate peer review.
As part of the implementation, NIH Director Elias A. Zerhouni,
M.D., announced the agency's commitment to spend $1 billion over
the next 5 years on investigator-initiated high-risk, high-impact
transformative research. Implementation of the recommendations is
expected to be carried out over the next 18 months.
The "diagnostic phase" of the peer review project resulted
in a Feb. 29 "Final
Draft Report" that addressed major challenges and outlined
the working groups' recommended actions. After a two-week public
comment period, an implementation group outlined implementation
plans for each recommended action. AAMC President and CEO Darrell
G. Kirch, M.D., had submitted a March 17 comment letter
regarding the draft report [see Washington
Highlights,
March 21].
Additional information about enhancing peer review at NIH and about
the implementation plan is available on the NIH website.
Information:
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Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
Report Recommends Support for Young Scientists,
High-Risk Research
The American Academy of Arts and Sciences June 3 released a report
recommending that the nation increase its support for early career
science faculty and encourage more "high-risk, high-reward,
potentially transformative" research. Developed by a blue-ribbon
committee chaired by Nobel Laureate and Howard Hughes Medical Institute
President Thomas Cech, Ph.D., the recommendations are described
as priorities for federal science funding agencies and should apply
regardless of fluctuations in available funding.
The ARISE (Advancing Research in Science and Engineering) report
notes that many science and technology funding agencies have become
"overly conservative, shying away from high-risk, high-reward
research and thus limiting the prospects of achieving breakthrough
results with the potential to transform a field." The report
recommends rebalancing the nation's research portfolio by investing
in targeted grant mechanisms and adopting policies that nurture
riskier research in all award programs.
Among the other recommendations, federal research agencies should
re-evaluate peer review systems, invest in program officers, and
more systematically track demographic data on investigators on a
government-wide basis. Additionally, the committee notes institutions
should reduce their reliance on "soft money" to support
investigators' salaries. Committee members admitted that this recommendation
would be difficult to implement, but called for consideration of
investigator support in long-term planning and development of new
facilities.
On young investigators, the committee noted that the average age
for first-time recipients of primary research grants from the National
Institutes of Health is 42.4 and rising, and that the success rate
for first-time grant applicants has declined from 86 percent in
1980 to 28 percent in 2007. The committee outlined steps that the
government, academic research institutions, and private foundations
can take to maintain a steady pipeline of science and engineering
talent, including targeted grants and seed funding programs for
early-career faculty, formalized mentoring for early-career scientists,
adjustments to university promotion and tenure policies, and attention
to the needs of primary caregivers.
Additional materials, including a full roster of committee members,
are available online.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
CBO Evaluates Potential Impact of Increased Price
Transparency for Health Care Services
The Congressional Budget Office (CBO) June 5 released a report
evaluating whether "increased transparency about prices for
specific health care services and pharmaceuticals would help to
temper the rapid growth in costs." The report indicates that
while "more transparency" would make provider charges
"more visible," it remains unclear whether such disclosures
ultimately would lead to higher or lower prices for consumers.
According to the report, "more than 80 percent of the population
is covered by some form of health insurance, which insulates people
from the full price of health care they consume, limiting their
incentive to compare prices." Similarly, spending on emergency
services is typically not a concern to both insured and uninsured
citizens. CBO points out that the nature of health care market competition
further complicates the ability to determine the ultimate impact
of transparency.
CBO concludes that added transparency for health care costs "probably"
would result in a reduction in the range of prices. Consumer awareness
of overall health care costs (particularly among those at greatest
need for health care services) "might" result in a greater
demand for effectiveness.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
On the Hill
The House Democratic Steering and Policy Committee June 5 appointed
Rep. Doris Matsui (D-Calif.) to the Committee on Energy and Commerce.
Rep. Matsui, who also sits on the Transportation and Infrastructure
Committee and the Rules Committee, will fill the committee seat
vacated by retired Rep. Albert Wynn (D-Md.).
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