Washington Highlights: April 10,
2009
AAMC Supports Rescission of "Provider Conscience"
Regulation
Contents
Prior Issues
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The AAMC April 8 submitted a letter
to the Department of Health and Human Services (HHS) supporting
the Obama administration's proposal
to rescind the regulation entitled "Ensuring That Department
of Health and Human Services Funds Do Not Support Coercive or Discriminatory
Policies or Practices in Violation of Federal Law." The letter
cites concerns the AAMC raised in a Sept. 23, 2008, comment letter
[see Washington Highlights,
Sept. 26, 2008], and notes that no evidence has surfaced to
suggest that protections provided to health care workers under current
laws are insufficient.
The Bush administration proposed the rule "to ensure that
Department funds to not support morally coercive or discriminatory
practices or policies." It was finalized in December 2008 and
became effective January 20, 2009.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
House Members Call for Increased NIH Funding
A bipartisan group of 128 Members of the House of Representatives
April 3 sent a letter
calling for an increase "of at least 7 percent" in funding
for the National Institutes of Health (NIH) in FY 2010. The letter,
which was sent to Reps. David Obey (D-Wis.) and Todd Tiahrt (R-Kan.),
the chair and ranking member, respectively, of the House Labor-HHS-Education
Appropriations Subcommittee, states this level of funding "is
essential to sustain advances in science and the economic impacts
of NIH-funded research."
The letter states, "NIH research is a critical part of health
care reform, strengthening our economy, inspiring the next generation
of scientists and researchers, and maintaining our nation's leadership
in innovation." Noting that "a substantial portion of
projected health care spending comes from expenses associated with
managing diabetes, cancer, Alzheimer's, stroke, and many other chronic
or life-threatening diseases," the letter avers that NIH research
"is essential to containing soaring health care costs."
The letter was organized by Reps. Ed Markey (D-Mass.), Dave Reichert
(R-Wash.), Janice Schakowsky (D-Ill.), Joe Courtney (D-Conn.), Michael
Castle (R-Del.), Susan Davis (D-Calif.), and Brian Bilbray (R-Calif.).
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
Representatives Urge Increased Investment in
Title VII
Reps. Diana DeGette (D-Colo.) and Cathy McMorris Rodgers (R-Wash.)
led an April 2 letter
signed by 68 Representatives urging a renewed investment in the
Title VII health professions training programs. The letter, addressed
to House Labor-HHS-Education Appropriations Subcommittee Chair David
Obey (D-Wis.) and Ranking Member Todd Tiahrt (R-Kan.), requests
$330 million for the programs in FY 2010 "to continue to improve
the distribution, quality, and diversity of the health professions
workforce in a manner that is consistent both with the needs of
the nation and the President's pledge to invest in strengthening
the health care workforce."
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
White House Briefs Stakeholders on Status of Recovery
Package
The AAMC April 9 attended a White House briefing on the status
of funds made available under the American Recovery and Reinvestment
Act (P.L.
111-5). At the briefing, Office of Management and Budget (OMB)
staff acknowledged ongoing problems with submitting applications
to the Grants.gov Web site. They reported that the government has
made "significant investments" to upgrade the website,
and that users will notice improvements "shortly." Additionally,
staff reported that "certain agencies" will be implementing
"alternative" means by which interested entities may obtain
and submit grant applications. They did not identify which agencies
might do so, nor did they offer any indication of when such changes
might be announced.
AAMC President and CEO Darrell G. Kirch, M.D., previously had sent
OMB Director Peter Orszag, Ph.D., a March 16 letter
expressing "grave concern" about operational problems
with the website and its potential to "hamper efforts to implement
the Recovery Act" [see Washington
Highlights, March 20].
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Ways and Means Hearing Focuses on Health Care
Reform
An April 1 House Ways and Means Committee hearing
discussed options to reform the health care delivery system. Among
the witnesses testifying was Medicare Payment Advisory Commission
(MedPAC) Chair Glenn Hackbarth, who proposed a Medicare payment
reduction for hospitals with "relatively high readmission rates
for select conditions." He encouraged the committee to allow
hospitals to "financially reward" physicians for reducing
readmissions and also recommended the bundling of Medicare payments
for a "hospitalization episode."
Also testifying at the hearing was Elliot Fisher, M.D., M.P.H.,
Director of Population Health and Policy at the Dartmouth Institute
for Health Policy and Clinical Practice, who urged the Centers for
Medicare and Medicaid Services (CMS) to "quickly establish
criteria" for the creation of "accountable care organizations"
(ACOs). Under the ACO model, a local network of providers manages
the full range of health care services for a specific patient population.
Dr. Fisher stated that Congress should "provide support and
incentives" for physicians in small group practices to form
ACOs. According to Chairman Hackbarth, MedPAC will continue its
own evaluation of ACOs at its April 8-9 meeting.
Dr. Fisher also urged the use of payment incentives to reduce an
apparent overutilization of services in certain regions of the country.
However, Robert Berenson, M.D., Senior Fellow at the Urban Institute,
advised that "there remains too much uncertainty about the
Dartmouth findings to ground public policy on them." According
to Dr. Berenson, the Urban Institute is currently studying geographic
variations in utilization "using an alternative methodology."
He reported that early findings appear to "cast doubt on both
the magnitude...and source of the variations that the Dartmouth
researchers found."
When asked by Rep. Allyson Schwartz (D-Pa.) for proposals to increase
the primary care workforce, Chairman Hackbarth urged improved payments
for primary care services. Dr. Berenson suggested using the medical
school application process to identify students who are more likely
to select a primary care career.
Also testifying at the hearing were Glenn Steele, Jr., M.D., Ph.D.,
President and Chief Medical Officer for Geisinger Health System,
and Lawrence Smith, M.D., CEO of North Shore-LIJ Health System.
Dr. Smith is also Dean of Hofstra University School of Medicine.
Dr. Steele spoke about Geisinger's successful implementation of
a medical home delivery model, used in conjunction with bundled
payments. Dr. Smith's testimony referred to his organization's participation
in the CMS/Premier Hospital Quality Incentive Demonstration project.
He stated that financial incentives "can and do improve patient
outcomes across a wide variety of measures and payers."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
NSABB Holds Conference on Personnel Reliability
The National Science Advisory Board on Biosecurity (NSABB) held
an April 3 conference
to receive public comments about developing personnel reliability
programs for academic and other scientists working with select agents,
including anthrax and other specified pathogens. The conference
included presentations from 15 leaders in academic research and
administration and in fields of psychometric research. Brian Herman,
Ph.D., Vice President for Research at the University of Texas Health
Science Center in San Antonio, and chair of the AAMC GRAND group,
presented the
institutional perspective. Dr. Herman warned that new regulation,
especially if not well designed, risks driving talented researchers
from important research and could even weaken the nation's ability
to respond to threats from select agents. Other presenters noted
the difficulties of assessing potential behavior and the extent
to which research with these agents is currently protected and scrutinized.
A report by NSABB is expected later this year.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
President Establishes White House Office of Health
Reform
President Obama April 8 issued an Executive Order
establishing a White House Office of Health Reform and directing
the Department of Health and Human Services to establish a coordinating
office within the department. According to the executive order,
the White House Office of Health Reform will "provide leadership
to the executive branch in establishing policies, priorities, and
objectives for the Federal Government's comprehensive effort to
improve access...quality...and the sustainability of the health
care system." The various functions of the newly established office
include the development and implementation of "strategic initiatives...to
strengthen the public agencies and private organizations that can
improve the performance of the health care system." The office also
will work with Congress "to eliminate unnecessary legislative, regulatory,
and other bureaucratic barriers that impede effective delivery of
efficient and high-quality care." The President March 2 named
Nancy-Ann DeParle Director of the White House office.
GAO Announces HIT Policy Committee Members
The Government Accountability Office (GAO) April 3 announced
the 13 inaugural members of the Health Information Technology Policy
Committee established by the American Recovery and Reinvestment
Act (ARRA, P.L.
111-5). The committee will make recommendations on the nation's
health information technology infrastructure, including standards
for the exchange of patient medical information.
ARRA required the Comptroller General to appoint committee members
across 10 categories of stakeholders. The Secretary of Health and
Human Services, the Majority and Minority Leaders of the Senate,
and the Speaker and the Minority Leader of the House of Representatives
will appoint an additional 7 committee members, and the President
can appoint other members as federal agency representatives.
The committee's "expert in health care quality measurement
and reporting" is David Bates, M.D., Medical Director for Clinical
and Quality Analysis at Partners HealthCare System, Inc., and Chief
of General Internal Medicine at Brigham & Women's Hospital.
Dr. Bates is one of five committee members who will serve the full
3-year term; other members' terms will be staggered.
On the Hill . . .
Illinois Democrat Mike Quigley won an April 7 special election
to fill White House Chief of Staff Rahm Emanuel's former House seat.
The Cook County commissioner will be sworn in when Congress returns
to Washington April 21.
A March 31 special election to fill Sen. Kirsten Gillibrand's (D-N.Y.)
vacated House seat remains undecided. Election officials April 8
began counting absentee ballots to determine the victor of a tie
between Democrat Scott Murphy and Republican James Tedisco.
A July 14 special election will determine the successor to California's
32nd Congressional District seat, formerly held by Secretary of
Labor Hilda Solis.
Additionally, Rep. Ellen Tauscher (D-Calif.) announced in a March
18 statement
that she had accepted an offer to serve as Undersecretary of State
for Arms Control and International Security. She is expected to
resign her House seat upon Senate confirmation, a process which
may take "weeks, if not months."
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