Washington Highlights: March 20,
2009
Ad Hoc Group Calls for Increase in NIH Budget
Contents
Prior Issues
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Stating that in the "post-stimulus" era, "we need
to make sure that the total funding available to NIH does not decline
and that we can resume a steady, sustainable growth that will enable
us to complete the President's vision of doubling our investment
in basic research," Mary J.C. Hendrix, Ph.D., urged Congress
to increase funding for NIH by at least 7 percent in FY 2010.
Dr. Hendrix, President and Scientific Director for the Children's
Memorial Research Center at Northwestern University's Feinberg School
of Medicine, testified
on behalf of the Ad Hoc Group for Medical Research during a March
18 public witness hearing before the House Labor-HHS-Education Appropriations
Subcommittee. She also is a member of the AAMC's Advisory Panel
on Research.
Noting she is an active cancer researcher who runs an institute
that employs more than 500 staff, Dr. Hendrix thanked Congress for
including "the extraordinary investment in medical research"
through NIH in the American Recovery and Reinvestment Act, as well
as the $938 million increase in NIH funding in the Omnibus Appropriations
Act for FY 2009. She told the subcommittee, "These are difficult
times for our nation and for people all around the globe, but the
affirmation of science as the key to a better future is a strategic
step forward. All of us in the medical research community are committed
to do our utmost to fulfill the faith that you and the American
people have placed in us."
Dr. Hendrix told the subcommittee, "The funding increases
in the ARRA and the FY 2009 omnibus will provide an immediate infusion
of funds into the nation's proven and highly competitive medical
research enterprise to sustain the pursuit of improved diagnostics,
better prevention strategies and new treatments for many devastating
and costly diseases…"
Cautioning that "Large fluctuations in funding will be disruptive
to training, to careers, long range projects and ultimately to progress,"
Dr. Hendrix emphasized, "The research engine needs a predictable,
sustained investment in science to maximize our return."
The AAMC is a member of the Steering Committee of Ad Hoc Group
for Medical Research, a coalition of more than 300 patient and voluntary
health groups, medical and scientific societies, academic and research
organizations, and industry.
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
HPNEC Request $550 Million for Titles VII and
VIII
Tina Cheng, M.D., M.P.H., chief of the Division of General Pediatrics
and Adolescent Medicine and Professor of Pediatrics and Public Health
at the Johns Hopkins University School of Medicine and Bloomberg
School of Public Health, March 18 testified
before the House Labor-HHS-Education Appropriations Subcommittee
on behalf of the Health Professions and Nursing Education Coalition
(HPNEC). Dr. Cheng, who also serves as president of the Academic
Pediatric Association, conveyed HPNEC's recommendation that the
subcommittee provide $550 million for Title VII and VIII health
professions and nursing education programs in FY 2010.
Thanking the subcommittee for health professions funding in the
American Recovery and Reinvestment Act (P.L. 111-5) and the FY 2009
Omnibus Appropriations Act (P.L. 111-8), Dr. Cheng emphasized that
"these investments provide a crucial springboard to begin to
wholly reverse chronic underfunding of these programs and address
existing and looming shortages of health professionals." Additionally,
she cited "numerous recent, highly regarded publications,"
including a December 2008 Institute of Medicine report which characterized
the programs as "an undervalued asset."
Witnesses for the Academic Family Medicine Advocacy Alliance, American
Association for Geriatric Psychiatry, and the American Dental Education
Association, also supported additional funding for Title VII programs
at the hearing. The AAMC coordinates HPNEC, a group of more than
60 national organizations advocating increased support for Title
VII and Title VIII.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
AAMC Registers Concern Over Status of Grants.gov
AAMC President and CEO Darrell G. Kirch, M.D., March 16 wrote
Peter Orszag, Ph.D., director of the Office of Management and Budget
(OMB), to register the AAMC's increasing concern about operational
problems with Grants.gov, the central portal for the federal government's
competitive grant programs. Dr. Kirch noted that, "The AAMC
has received messages of grave concern from our constituents about
major service and operational deficiencies in the program and fear
that increased deterioration in this essential service as volume
increases may hamper efforts to implement the Recovery Act [P.L.
111-5]."
Dr. Kirch asked Dr. Orszag to provide on-going oversight of the
Grants.gov system to ensure it is adequately resourced and staffed:
"We urge that you and your colleagues work to ensure that adequate
resources are allocated to solve the short- and long-term operational
problems with Grants.gov."
Dr. Kirch also asked that Dr. Orszag "authorize the agencies
managing the competitive grant programs functioning within the system
to provide applicants with appropriate flexibility to compensate
for the performance flaws currently in evidence with the system."
Dr. Kirch said, "No applicant should be disadvantaged by an
inadequate or malfunctioning application submission portal."
OMB has noted that problems with the Grants.gov system pose a major
risk to the effective dissemination of Recovery Act resources. The
National Institutes of Health (NIH) March 16 extended
by one day a grant submission deadline due to problems with the
HHS-managed resource on that date. NIH said, "We will continue
to closely monitor the situation at Grants.gov and will make adjustments
as necessary to ensure applicants' ability to submit on-time."
It is expected that NIH may revert applications for some mechanisms
to paper should performance woes continue with the Grants.gov portal.
Information:
Tony Mazzaschi, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
Ways and Means Subcommittee Discusses MedPAC Annual
Report
A March 17 Ways and Means Subcommittee on Health hearing
focused on the Medicare Payment Advisory Commission's (MedPAC) March
Report
to Congress on the Medicare Payment Policy. Subcommittee Chair Pete
Stark (D-Calif.) in his opening statement
said, "Improvements to Medicare and reforms to the program
must be, and will be, part of this year's larger health care reform
agenda. As we pursue comprehensive health reform, MedPAC's insight
into health delivery and spending in Medicare is of great value."
MedPAC Chair Glenn Hackbarth, J.D., in his opening statement discussed
and made recommendations for Medicare fee-for-service (FFS) payment
systems and the Medicare Advantage (MA) program. He also discussed
other key health care initiatives including a greater investment
in information about comparative effectiveness and medical home
as a mechanism for coordinated care.
During the hearing Rep. Shelley Berkley (D-Nev.) raised concerns
about a current shortage of primary care providers and specialists
in certain areas of the country. In his response, Chairman Hackbarth
agreed that fewer medical students are seeking careers in primary
care, largely due to poor reimbursement levels. He added that physician
shortages of any time threaten to reduce the quality, as well as
availability, of health care services.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
MedPAC Discusses Medical Education Project
At its March 12-13 meeting,
the Medicare Payment Advisory Commission (MedPAC) discussed a project
entitled "Medical education in the U.S. - Is it supporting
needed delivery system reforms?" MedPAC staff presented a draft
chapter of this project for possible inclusion in the commission's
June Report to Congress. This issue was first addressed at the commission's
October meeting when they heard from a three-person panel on medical
education [see Washington
Highlights, Oct.
10, 2008].
MedPAC staff presented findings from a study that looked at whether
residency training programs equip future physicians with the skills
they need to implement the delivery system changes MedPAC has recommended
in recent years. The study was conducted by RAND researchers who
conducted 26 semi-structured interviews with internal medicine program
directors to assess the extent to which their program curricula
focused on the following topics: practice-based learning, system-based
practice, interpersonal communication, health information technology
(IT), and training in non-hospital settings.
The preliminary survey results show that most programs interviewed
provide at least some training in the selected topics, but overall
their curricula fall short of providing the full range. For example,
programs generally include instruction on evidence-based medicine
and communication about end-of-life care, but lack formal training
and experience in areas such as outpatient care coordination, multidisciplinary
teamwork, awareness of health care costs, comprehensive health IT,
and training in non-hospital settings. MedPAC staff noted that some
of the factors that affect programs' curricula include the amount
of faculty expertise; residents' baseline level of skills and knowledge;
and a dearth of information on the best educational methods for
teaching residents in topics such as care coordination. MedPAC staff
also pointed out that Medicare regulations regarding residency training
in nonhospital sites appear to be a major barrier that discourages
training in ambulatory sites, such as physician offices.
Following the presentation, commissioners discussed issues related
to medical education that need further investigation. These issues
range from the role of undergraduate education and accreditation
to how Medicare can better address workforce issues and foster continuing
medical education.
Commissioner Peter Butler, COO of Rush University Medical Center,
wrapped up the session by expressing his support for the inclusion
of a chapter on medical education in the June report. He also suggested
that further staff work should include interviews with Designated
Institutional Officers (DIOs), who are responsible for all of the
residency programs at their respective institutions.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
AAMC Asks CMS to Begin a New Effort on Clinical
Trial Policy
The AAMC sent a March 12 letter
to the Centers for Medicare and Medicaid Services (CMS) requesting
it begin a new effort on setting requirements for Medicare coverage
of clinical trials. The AAMC letter notes that the CMS policy on
clinical trials is "confusing to implement, lacking consistency
with other Medicare policies that affect clinical trials, and variable
in its application due to differing interpretations by Medicare
contractors."
The letter states that, to date, CMS has been unsuccessful in clarifying
the clinical trial policy that was initially issued in 2000. The
AAMC suggests that a new effort should have the dual goals of: 1)
increasing the enrollment of Medicare beneficiaries in clinical
trials; and 2) giving providers sufficient clarity about the requirements.
The AAMC also urges CMS to issue this new policy through rulemaking,
not through the national coverage decision (NCD) that is the current
vehicle for the clinical trials policy. According to the letter,
"The NCD process was never intended to tackle the complexities
raised by clinical trial coverage and should no longer be used for
that purpose."
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
AAMC Supports Transparency in Regulatory Review
Process
The AAMC March 16 submitted a response to the Office of Management
and Budget's (OMB's) Feb. 26 request for public comments on the
principles and procedures governing regulatory review. The AAMC
letter asks
for increased transparency in the regulatory process, including
more frequent use of the Advanced Notice of Proposed Rulemaking.
The AAMC also recommends that data used to support a proposal should
be made available to the public at the time the proposed regulation
is released to allow time for data analysis and an assessment of
the impact of the proposal. The AAMC suggests that federal agencies
establish clear guidelines to distinguish when an agency is making
a "clarification" and when it is establishing new policy.
The letter also expressed concern about the cumulative effect, both
in terms of cost and administrative burden, of federal regulations
on academic medicine, particularly biomedical research.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
HHS Names David Blumenthal As National Coordinator
for Health Information Technology
The Department of Health and Human Services (HHS) March 20 announced
the selection of David Blumenthal, M.D., M.P.P., as the Obama Administration's
choice for National Coordinator for Health Information Technology.
As the National Coordinator, Dr. Blumenthal will lead the implementation
of a nationwide interoperable, privacy-protected health information
technology infrastructure as called for in the American Recovery
and Reinvestment Act (ARRA, P.L.
111-5). The ARRA includes a $19.5 billion investment in health
information technology.
"Health information technology is a critical part of the President's
strategy to reform our health care system and as one of the nation's
leading health information technology experts, Dr. Blumenthal has
the experience and the vision to help make this effort a reality,"
said HHS spokeswoman Jenny Backus.
Dr. Blumenthal most recently served as a physician and director
of the Institute for Health Policy at The Massachusetts General
Hospital/Partners HealthCare System in Boston, Mass. He was also
Samuel O. Thier Professor of Medicine and Professor of Health Care
Policy at Harvard Medical School. There, he also served as director
of the Harvard University Interfaculty Program for Health Systems
Improvement. Prior to that, he was senior vice president at Boston's
Brigham and Women's Hospital and served as executive director of
the Center for Health Policy and Management and as a lecturer on
Public Policy at the John F. Kennedy School of Government.
During the late 1970's, Dr. Blumenthal worked on Senator Edward
Kennedy's Senate Subcommittee on Health and Scientific Research.
More recently, Dr. Blumenthal served as a senior health adviser
to the Obama for America campaign.
NSF Describes Recovery Act Implementation
The National Science Foundation (NSF) March 18 issued a notice
to presidents of colleges and universities and heads of other NSF
awardee institutions, describing plans for implementing the $3 billion
provided to NSF through the American Recovery and Reinvestment Act
(ARRA, P.L.
111-5). According to the notice, the "majority" of the
$2 billion allocated for research and related activities will be used
for unfunded, highly rated proposals "that are already in house
and will be reviewed and/or awarded prior to September 30, 2009."
Program officers also will contact institutions whose high quality
proposals were declined on or after Oct. 1, 2008, due to lack of funding;
some of these decisions may be reversed. Additionally, this spring
NSF plans to post ARRA-supported solicitations for its Major Research
Instrumentation program, Academic Research Infrastructure program,
and the Science Masters program.
The notice specifies that ARRA-funded grants will be "standard
grants with durations of up to 5 years … [which] will allow
NSF to structure a sustainable portfolio." NSF also plans to
prioritize funding for new investigators and high-risk, high-return
research projects. Additional information about ARRA-related procedures
and weekly reports on disbursements and obligations is available
on the NSF's Recovery Act website.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
HHS Announces Members of CER Coordinating Council
The U.S. Department of Health and Human Services (HHS) March 19
announced members
of a newly created 15-person council to help coordinate and guide
investments in comparative effectiveness research (CER) funded by
the American Recovery and Reinvestment Act (ARRA, P.L.
111-5). The Federal Coordinating Council for Comparative Effectiveness
Research will assist federal agencies in coordinating research
to help determine the "relative strengths and weaknesses of
various medical interventions;" develop ways to build and expand
on current priorities; and issue recommendations on how to utilize
$400 million allocated to the HHS Secretary through the ARRA to
advance CER. As specified in the Recovery Act, the council will
not recommend clinical guidelines for payment, coverage or treatment.
Twelve of the members represent agencies or offices within HHS;
a representative from the Veterans Administration, the Department
of Defense, and the Office of Management and Budget also were named
to the group. The council will hold a public listening session on
April 14 to receive public input and ensure all deliberations are
open and transparent.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Sen. Conrad Introduces Visa Waiver Program Reform
Senator Kent Conrad (D-N.D.), March 18 introduced
a bill (S. 628) to authorize the Conrad State 30 permanently with
additional reforms. The bill is similar to legislation he sponsored
in the 110th Congress (S.
2672).
Congress March 11 passed legislation (H.R.
1127) to extend through Sept. 30, 2009, the Conrad State 30
program, sending the bill to the President for his signature. The
legislation was introduced Feb. 23 by Rep. Zoe Lofgren (D-Calif.),
to prevent the program's March 6 expiration.
Currently, the Conrad State 30 program allows physicians on J-1
visas to waive the J-1 requirement to return to their home country
for two years if they agree to serve for three years in a U.S. underserved
area. Each state is allowed 30 such waivers.
Like the previous version, S. 628 would:
- Permanently authorize the Conrad State 30 program;
- Allow physicians on H-1B visas to enter the program;
- Exempt physicians who participate in the program from green
card caps; and
- Provide a mechanism by which the per state caps can increase
beyond 30 waivers.
S. 628 would also prohibit H-1B visa physicians from serving in
"flex-slots," positions located outside underserved areas.
Additionally, it would reset H-1B visa physicians' visa expiration
to 6 years from the time they enter the Conrad State 30 program.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
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