Washington Highlights: July 18,
2008
Congressional Override Secures Medicare Physician
Payment Relief
Contents
Prior Issues
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By overwhelming majorities in the House (383-41) and Senate (70-26),
Congress July 15 voted to override President Bush's veto of the
"Medicare Improvement for Patients and Providers Act of 2008"
(P.L.
110-275), thereby securing 18 months of AAMC-supported Medicare
physician payment relief. The new law extends through Dec. 31, 2008,
the 0.5 percent Medicare physician conversion factor update that
expired July 1 (reversing a 10.6 percent cut). It also averts a
projected 5.4 percent cut for CY 2009 by establishing a 1.1 percent
physician payment update for the full year. Additionally, the law
extends and increases to 2 percent incentive payments for physician
quality reporting in CY 2009 and CY 2010.
To offset partially the costs associated with the physician payment
provisions, P.L. 110-275 requires the Centers for Medicare and Medicaid
Services (CMS) to calculate subsequent conversion factor updates
as though the 10.6 percent and 5.4 percent cuts were implemented
(e.g., CMS would reduce the CY 2010 conversion factor by over 20
percent). The new law also partially offsets the physician-related
costs by phasing-out the indirect medical education (IME) adjustment
contained in the Medicare Advantage payment calculation (i.e., it
does not affect the IME payments made directly to teaching hospitals
for treating Medicare Advantage patients).
Upon enactment of the Medicare bill, AAMC President and CEO Darrell
G. Kirch, M.D., stated
that "We hope legislators realize that temporarily adjusting
physician payments, without attending to broader issues, could have
a devastating effect on the millions of Medicare patients who count
on the nation's 100,000 teaching physicians for routine care, as
well as services unavailable elsewhere in their communities."
Dr. Kirch urged Congress, the next administration, providers, and
beneficiaries to "work together to develop a long-term, sustainable
solution to the problems that plague the current system for reimbursing
physicians."
The new law contains other provisions of interest to medical schools
and teaching hospitals:
- Permits (effective Jan. 1, 2010) teaching anesthesiologists
involved in the training of residents to receive full reimbursement
for up to two concurrent cases;
- Extends through Jan. 1, 2010 the current "floor"
on Medicare's geographic adjustment for physician work ("work
GPCI");
- Establishes a physician quality reporting process for group
practices;
- Requires an Institute of Medicine report on best practices
for the review of comparative effectiveness research and the development
of clinical protocols; and
- Establishes a framework for the implementation of incentive
payments for electronic prescribing.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
AAMC, Associations Comment on "Dual-Use" Oversight
Framework
The AAMC and five other higher education and science associations
submitted written
comments to the Department of Health and Human Services (HHS)
at a July 15 meeting on a proposed framework for oversight of "dual-use"
biological research at universities and other research organizations.
The term dual-use refers to legitimate scientific research that
could be misused to harm individuals or society. The oversight framework
was a product of the National Science Advisory Board on Biosecurity
(NSABB), which last year submitted the draft document to HHS and
the Administration for review [see Washington
Highlights, April 27, 2007].
The associations' comment letter was led by the Federation of American
Societies for Experimental Biology, and was endorsed by the AAMC,
the Association of American Universities, the American Association
for the Advancement of Science, the Council on Governmental Relations,
and the National Association of State Universities and Land-Grant
Colleges. The letter urges the Administration not to develop regulation
or guidance until the several aspects, and specifically provisions
affecting university obligations under an oversight system, can
be better defined. The associations recommend continued communication
with the scientific community and public education on the issue,
to help develop better consensus on what constitutes dual-use research
of concern and the precautions needed to minimize risk of misuse.
A panel of institutional representatives echoed the associations'
comments at the July 15 meeting. Among the presenters were Richard
Marchase, Ph.D., Professor and Vice President for Research and Economic
Development at the University of Alabama, Birmingham, and Samuel
Stanley, Jr., M.D., Vice Chancellor for Research at Washington University
in St. Louis.
The framework will remain under review at HHS, with input from
other agencies, including the White House Homeland Security Council.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
Senators Propose Additional $5.2 Billion for NIH
at Subcommittee Hearing
Director of the National Institutes of Health (NIH) Elias Zerhouni,
M.D., testified July 16 before the Senate Labor-HHS-Education Appropriations
Subcommittee, as Subcommittee Chair Tom Harkin (D-Iowa) and Ranking
Member Arlen Specter (R-Pa.) announced legislation (S.3272) to provide
$5.2 billion in supplementary FY 2008 emergency funding for NIH.
According to Chairman Harkin, the additional funding "would
be enough to restore the purchasing power of NIH that was lost to
inflation since the end of the doubling period, plus provide $1.2
billion specifically for the National Cancer Institute, in line
with NCI's professional judgment bypass budget."
Dr. Zerhouni was accompanied by National Human Genome Research
Institute Director Francis Collins, M.D., Ph.D.; National Institute
of Allergy and Infectious Diseases Director Anthony Fauci, M.D.;
National Heart, Lung, and Blood Institute Director Elizabeth Nabel,
M.D.; and National Cancer Institute Director John Niederhuber, M.D.
All provided examples of projects that were not occurring due to
budget constraints.
Dr. Zerhouni described for the panel an "explosion of knowledge"
over the last several years, noting that each new discovery marks
the beginning of further research and requires additional investments.
Further, Dr. Zerhouni explained that medical research is a long-term
process; if young scientists are to commit their lives to a research
career, they must feel confident that the funding will be sustained
throughout their careers. In response to a question from Chairman
Harkin, Dr. Zerhouni projected a need to fund 3,000 new NIH scientists
each year and stated that the nation currently is not meeting that
threshold.
When asked by full Committee Ranking Member Thad Cochran (R-Miss.)
how NIH would use an additional $1 billion in funding, Dr. Zerhouni
outlined 3 priorities: (1) create a "lockbox" within the
budget to fund the next generation of scientists; (2) invest in
physical resources across the country to develop a stronger infrastructure
for conducting research and clinical trials; and (3) encourage breakthrough
innovations and collaborations across the sciences. He added that
NIH is investing in all three areas, but budget constraints - and
an additional $1 billion - do not allow for sufficient investments
in these areas.
Subcommittee members inquired about the status of research in specific
areas, including cancer, autism, post-traumatic stress disorder,
pandemic flu, and others. Senator Dick Durbin (D-Ill.) wondered
whether Congress "ties" the hands of scientists by funding
its priorities instead of appropriating NIH funding in aggregate.
On conflicts of interest, Dr. Zerhouni stressed the importance
of finding a balance that preserves the public trust while maintaining
contributions to the public good that result from certain collaborations.
Chairman Harkin referred to the AAMC-Association of American Universities
report
on implementing conflicts of interest policies, and Dr. Zerhouni
noted that "sunshine" on researchers' financial interests
is an important step.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Senate Appropriations Committee Approves VA Research
Increase
The full Senate Appropriations Committee July 17 approved the FY
2009 VA Military Construction and Veterans Affairs spending bill.
According to a press
release by the committee, the bill provides $526.8 million for
the VA Medical and Prosthetic Research program, a $46.8 million
(9.8 percent) increase over FY 2008 and $84 million more than the
President's request.
The House Committee on Appropriations approved its VA appropriations
bill June 24 [see Washington
Highlights, June 27]. For VA Research, the House Committee
approved $500 million, a $20 million (4.2 percent) increase over
FY 2008 and $58 million more than the President's request.
The Friends of VA Medical Care and Health Research (FOVA) recommend
$555 million for VA research in FY 2009, a $75 million (15.6 percent)
increase over FY 2008. The AAMC is a member of the FOVA executive
committee.
Informaton:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House Judiciary Committee Approves False Claims
Act Amendments
The House Judiciary Committee July 16 approved by voice vote an
amended version of legislation to amend the False Claims Act (FCA).
Supporters of the "False Claims Act Correction Act" (H.R.
4854) say it addresses concerns that recent federal court decisions
have narrowed the application of the federal False Claims Act since
it was last amended in 1986.
The Manager's Amendment, offered by Rep. Howard Berman (D-Calif.),
the author of H.R. 4854, narrowed the bill to prevent lawsuits for
hospital overpayments before periods of reconciliation when overpayments
can be repaid to the government. Berman's amendment also set the
statute of limitations for bringing a suit under the FCA to 8 years,
a compromise between the bill's original 10-year limit and the current
tiered system with multiple limits.
The panel also adopted by voice vote an amendment by Rep. James
Sensenbrenner (R-Wis.) that struck a section of the bill regarding
the government's right to move to dismiss certain cases brought
by federal employees.
In a July 16 statement,
Lisa Rickard, president of the U.S. Chamber Institute for Legal
Reform, indicated "the revisions would expand the FCA beyond
simply those doing business with the government to include those
doing business with any entity which receives government funds,
creating whole new categories of targets for the plaintiffs' bar,
including scientists and artists, health clinics and homeless shelters,
state and local governments, and universities and colleges."
The Senate Judiciary Committee April 3 approved similar legislation
(S. 2041), sponsored by Sen. Charles Grassley (R-Iowa) [see Washington
Highlights, April 4]. The AAMC joined 20 organizations on
a July 15 letter
to Reps. John Conyers, Jr. (D-Mich.), and Lamar Smith (R-Texas),
the chair and ranking member, respectively of the House Judiciary
Committee, opposing H.R. 4854 as introduced.
Informaton:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
HELP Committee Holds Education Focused Hearing
on the ADA Amendments Act
The Senate Committee on Health, Education, Labor and Pensions July
15 held a hearing
on amending the Americans with Disabilities Act (ADA). The "ADA
Amendments Act" (H.R.
3195), which passed the House June 25, is designed to broaden
the definition of "disability," which the Supreme Court
has narrowed through a variety of court decisions since the 1990
introduction of the ADA. The proposed legislation eliminates the
idea set forth by the Supreme Court that mitigating measures should
play a part in determining whether an individual has a disability,
and clarifies the definition of "substantially limits"
with regard to the effect a disability has on major activities in
a person's life.
Senator Tom Harkin (D-Iowa), who is the sponsor of the Senate's
"ADA Restoration Act" (S. 1881), expressed the Committee's
desire to hear about the concerns of the education community. The
8-person panel included 3 witnesses entirely focused on education.
Jo Anne Simon, Esq., in support of the legislation stated it will
not have a significant impact on the number of students requesting
accommodations through the ADA. Sue Gamm, primary consultant with
Public Consulting Group, testified that the legislation will allow
more children, many of whom may not truly need accommodations, to
apply for them and have their requests granted. Terry Hartle, senior
vice president at the American Council on Education, stated that
this legislation will increase the already large number of accommodation
requests being processed by universities, and also threatens to
diminish the quality of many universities and educational programs.
The AAMC joined with 7 other educational testing groups to send
letters to both the House
and Senate
expressing their concerns that the legislation may have unintended
and negative consequences on entities that rely on standardized
tests, on higher education, and on the public. The letter notes
that testing accommodations "raise three main areas of concern:
score comparability, fairness, and issues of public health and welfare."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
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