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Washington Highlights: October 24, 2008

AAMC Submits ICD-10 Comment Letter

The AAMC Oct. 10 submitted a comment letter (PDF, 1 page) on a Department of Health and Human Services (HHS) proposed rule that would replace the current ICD-9 codes set -used to report health care diagnoses and procedures on health care transaction claims- with a new version, known as ICD-10. According to HHS, the move is necessary because the ICD-9 code set is "outdated, with only a limited ability to accommodate new procedures and diagnoses." The department also noted that the ICD-10 code set would support comprehensive reporting of quality data and ensure more accurate payments for new procedures.

The AAMC comment letter acknowledges the need to move to ICD-10, but emphasizes the significant challenges and costs (for both hospitals and physicians) associated with this change. The letter urges HHS to include in the final rule a definitive list of governmental outreach activities that it would undertake as well as to announce publicly and specifically its level of financial commitment to this initiative.

As did other commenters, the AAMC stated that the proposed Oct. 1, 2011, implementation date is "unrealistic" and urged that the timeframe be revised. In addition, the association asked the department to pay particular attention to major teaching hospitals and their associate physician practices to ensure that any unique needs of these institutions are addressed expeditiously.

Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140

Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490

CMS Issues Annual Actuarial Report on Medicaid

The Centers for Medicare and Medicaid Services (CMS) Office of the Actuary Oct. 17 issued its first annual "Actuarial Report on the Financial Outlook for Medicaid." The new report follows a format similar to the annual update released by the Medicare Board of Trustees. A CMS press release states that future issues of the Medicaid actuarial report will "expand on content to include long-range projections and more extensive analysis."

According to the newly issued report, combined state/federal spending on Medicaid benefits will grow by an annual rate of about 7.9 percent over the next 10 years (OMB projects that annual GDP growth will average about 4.8 percent). By 2017, Medicaid expenditures will total nearly $674 billion, with the federal share exceeding $383 billion. In 2006, Medicaid represented 14.8 percent of the nation's total health care spending. Under current law, the Medicaid program is projected to account for 8.4 percent of the entire federal budget by 2013, a 1.4 percent increase from 2007.

Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526

APHIS Proposes Requiring Contingency Planning for Research Animals

The USDA's Animal and Plant Health Inspection (APHIS) Service Oct. 23 published in the Federal Register a proposed rule to amend the Animal Welfare Act (AWA) regulations to require research facilities and others covered by the AWA to develop contingency plans and related training of personnel. In an Oct. 23 press release, APHIS stated that it believes "all licensees and registrants should develop a contingency plan for all animals regulated under the [AWA] in an effort to better prepare for potential disasters."

APHIS is proposing that mandatory elements in the contingency plan include:

  • Identify situations the facility might experience that would trigger the need for a contingency plan;
  • Outline specific tasks required to be carried out in response to the identified emergencies;
  • Identify a chain of command and who (by name or by position title) will be responsible for fulfilling these tasks; and
  • Address how response and recovery will be handled in terms of materials, resources, and training needed.

In addition, APHIS indicated it also is considering the development of a guidance document or other resources to provide examples of elements that may be included in contingency plans. The agency is seeking comment on issues related to developing such guidance. Comments on the proposed rule are due on or before Dec. 22.

Information:
Tony Mazzaschi, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059

Issue Brief Outlines Challenges to Adoption of Health Information Technology

According to an October 2008 issue brief from the non-partisan, non-profit Alliance for Health Reform, privacy worries, investment costs, and a lack of electronic standards remain obstacles to the wide-spread adoption of health information technology (HIT). The issue brief, "Health Information Technology: More than the Money" (PDF, 4 pages), features examples of public and private "innovation and experimentation" to promote HIT adoption, including state electronic prescribing initiatives and provider partnerships with Google and Microsoft. According to the issue brief, many policy experts continue to believe the federal government should consider "financial incentives to drive broader scale HIT adoption." It states that small financial incentives may not be effective, but advises that "larger incentives" could prove "too costly to the government."

Sens. John Rockefeller (D-W.V.) and Susan Collins (R-Maine) serve as honorary co-chairs of the Alliance for Health Reform. Among the Alliance's board members are Robert Graham, M.D., Professor and the Robert and Myfanwy Smith Chair in the Department of Family Medicine, University of Cincinnati College of Medicine; James Tallon, Jr., United Hospital Fund of New York; Nancy Dickey, M.D., President, Texas A&M University Health Science Center; William Novelli, Chief Executive Officer, AARP; and Reed Tuckson, M.D., Executive Vice President and Chief of Medical Affairs, UnitedHealth Group.

Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526