Washington Highlights: September
19, 2008
House Passes ADA Amendments
Contents
Prior Issues
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The House of Representatives Sept. 17 passed the "ADA Amendments
Act of 2008" (S.
3406) by voice vote, clearing the measure for the President,
who is expected to sign the bill. The bill clarifies and broadens
the definition of disability and expands eligibility for protections
under the Americans with Disabilities Act (ADA). The legislation
also reverses several recent Supreme Court decisions that narrowed
the scope of protections available under the original statute. The
Senate passed the bill Sept. 11 [see Washington
Highlights, Sept. 12].
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
Committee Approves Loans for Establishing Rural
Residency Programs
The House Energy and Commerce Committee Sept. 17 amended and passed by voice vote legislation that would create by FY 2010
a loan program for establishing residency training programs in rural
areas. Introduced by Reps. Michael Burgess (R-Texas), a physician,
and Jim Matheson (D-Utah), the committee-passed version of the "Physician
Workforce Enhancement Act of 2007" (H.R.
2583) would provide eligible public and non-profit hospitals
with up to $250,000 annually in interest free loans to establish
residency programs in family medicine, internal medicine, obstetrics/gynecology,
behavioral/mental health, or pediatrics. Committee Chair John Dingell
(D-Mich.) called H.R. 2583 a "small down payment of what should
be done" to address a "terrible shortage" of physicians.
Under the amended version of H.R. 2583, hospitals must commence
repayment within 18 months of receiving the loan, complete repayment
within 24 months, and use the funds "only for costs directly
attributable" to the training program. Recipients terminating
the residency programs before full repayment of the loans would
face financial penalties. The bill authorizes the loan program under
Title VII of the Public Health Service Act at the following funding
levels: $8 million in FY 2010; $8.4 million in FY 2011; $8.82 million
in FY 2012; $9.26 million in FY 2013; and $9.72 million in FY 2014.
No loans may be awarded after December 31, 2013.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
House Panel Mulls Physician Payment Reform Options
Witnesses at a Sept. 11 House Ways and Means Health Subcommittee
hearing discussed Medicare physician payment reforms that Congress
should consider before January 2010. Without Congressional intervention,
the calendar year (CY) 2010 conversion factor reduction is projected
to exceed 20 percent. In his opening remarks, Subcommittee Chair
Pete Stark (D-Calif.) stated, "We need to ... examine payment
system reforms that encourage better care coordination, higher quality
care, and more efficient use of resources."
Former Health Care Financing Administration (now the Centers for
Medicare and Medicaid Services, or "CMS") Administrators
Bruce Vladeck, Ph.D., and Gail Wilensky, Ph.D., testified that Congress
should act immediately to improve the valuation of primary care
services under the Medicare fee schedule, as recommended by the
Medicare Payment Advisory Commission (MedPAC). According to Dr.
Vladeck, such action, under a budget-neutral adjustment, "will
actually save some money" since it "reduce[s] the relative
prices of procedural services, and thus the size of the incentives
for physicians to increase the volume of them." Dr. Vladeck
pointed to an "alarming" decline in medical students who
select a career in primary care, "in part because medical students
and residents are sensitive to the income implications of specialty
choices."
Drs. Vladeck and Wilensky supported the "medical home"
model, which also was recommended by MedPAC, calling it "a
good way to encourage more coordinated care in a world where most
beneficiaries still receive care in a fragmented fee for service
setting." They also encouraged Congress to "revive"
loan forgiveness programs that encouraged primary care physicians
to practice in shortage areas.
During the hearing, Drs. Vladeck and Wilensky suggested rewarding
physicians that practice in large, multispecialty groups. Citing
"two generations of data confirming that such practices outperform
other models of physician organization in cost, quality, and care
coordination," Dr. Vladeck urged Congress to explore "methods"
(such as financial incentives) that encourage greater physician
participation in such groups. He stated that "we will never
develop adequately satisfactory alternatives to our current payment
methods until a far larger proportion of American physicians are
organized in multi-specialty group practices, whether free-standing
or hospital-based." He added that "the behaviors of health
care providers are affected by many things" beyond financial
incentives, including "peer pressure and their own aspirations
to professional excellence."
Dr. Wilensky suggested that (in the short-term) multispecialty
group practices could be granted their own Medicare spending targets
"in order to reward and incent their membership and make participation
in multispecialty practices more attractive to the physician population."
She also suggested that CMS encourage contractors to "more
aggressively review billing and medical records of physicians who
are clear 'outliers' in terms of their prescribing or use of medical
procedures and ancillary services."
Also testifying at the hearing were American Medical Association
President Nancy Neilson, M.D., Ph.D., and California Association
of Physician Groups President and CEO Donald Crane. Dr. Neilson
urged Congress to rebase the Sustainable Growth Rate (SGR) to reflect
recent Congressional interventions and avert the cumulative reduction
scheduled for FY 2010. Mr. Crane testified in support of capitated
payments for physicians.
Additional information on the hearing is available on the committee
website.
Informaton:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senate Finance Committee Discusses Health Care
Delivery System Reform
The Senate Finance Committee Sept. 16 held a hearing on health
care delivery system reform. Witnesses suggested an increase in
Medicare reimbursements for primary care, revisions to the current
physician payment system, and that a pilot program exploring the
increased use of medical homes for beneficiaries ultimately would
reduce costs and improve the overall quality and coordination of
U.S. health care system. Committee Chair Max Baucus (D-Mont.) said,
"The health care system, which in most cases reimburses providers
based on the number of services performed rather than the quality
of care delivered, accounts for more than $600 billion annually
spent unnecessarily on low-quality health care."
Medicare Payment Advisory Commission (MedPAC) Executive Director
Mark Miller, Ph.D., echoed Chairman Baucus's remarks, recommending
the need to link physician payments to quality not quantity. He
said, "Medicare should change payment system incentives by
basing a portion of provider payment on the quality of care they
provide," and recommended "that the Congress establish
a quality incentive payment policy for physicians." Glenn Steele,
M.D., Ph.D., President and CEO of Geisinger Health System, agreed
by saying, "What we need to do is reward good clinical practice
and not reward bad practice. Paying for readmitting a patient for
an infection that should have been prevented is unacceptable."
Additional information about the hearing is available on the committee
website.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Rep. Stark Introduces Medicare HIT Incentives
Bill
House Ways and Means Committee Chair Pete Stark (D-Calif.) Sept.
15 introduced the "Health-e Information Technology Act of 2008"
(H.R. 6898), a bill that seeks to promote the widespread adoption
of health information technology (HIT) through provider incentives
and increased health information privacy protections.
The bill establishes by 2013 Medicare incentive payments for physicians
(including group practices) and hospitals that demonstrate a "meaningful
use" of a certified electronic medical record system (as determined
by the Secretary). The bill establishes a maximum level of bonus
payments, phases-out the physician bonus over 5 years, and phases-out
the hospital bonus over 3 years. A hospital's payments would reflect
total discharges adjusted by its Medicare share and its level of
charity care. Starting in 2016, Medicare will reduce payments to
physicians and hospitals that have not implemented such a system.
The names, addresses, and phone numbers of "meaningful users"
(physicians and hospitals) would be posted on the CMS website.
The bill also extends to business associates existing privacy requirements
and penalties that currently apply to physicians, health plans,
and health care clearinghouses. Additionally, the measure prohibits
the sale of personal health information and directs the Secretary
to promulgate regulations that identify which activities within
"health care operations" can "reasonably and efficiently
be conducted through the use of de-identified data" and which
would require a patient's "valid authorization" to disclose.
The bill stipulates that treatment cannot be conditioned upon the
provision of valid authorization.
The measure reportedly builds on the PRO(TECH)T Act (H.R.
6357), which the House Energy and Commerce Committee approved
July 23 [see Washington Highlights,
July 25]. Additional information on H.R. 6898, including bill
text and committee-prepared summaries, is available on Rep. Stark's
website.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
NIAAA Director to Step Down
Ting-Kai Li, M.D., Director of the National Institute on Alcohol
Abuse and Alcoholism (NIAAA) of the National Institutes of Health
(NIH), announced Sept. 18 that he will retire from Federal service
effective Oct. 31. NIAAA Deputy Director Kenneth R. Warren, Ph.D.,
will serve as Acting Director of the Institute upon Dr. Li's departure.
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