Washington Highlights: April 24,
2009
Congress Moves Budget Resolution Forward, AAMC
Urges Support of Health Provisions
Contents
Prior Issues
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The House April 22 agreed to an amendment in the nature of a substitute
to the Senate-passed FY 2010 budget resolution (S.
Con. Res. 13). The substitute replaces the Senate-passed language
with provisions of the House-passed budget resolution (H.
Con. Res. 85), including budget reconciliation instructions
for the House Committees on Energy and Commerce and Ways and Means
and a place-holder for Senate reconciliation instructions [see Washington
Highlights, March 27].
The Senate April 23 voted on several motions to instruct conferees.
In the House, efforts by Rep. Paul Ryan (R-Wis.) to remove the
reconciliation instructions failed by a vote of 196-227. Concerned
that the reconciliation instructions would be used to limit debate
on health care reform and other leading issues, Rep. Ryan stated
"if we're going to have debate about nationalizing the health
care system in America ... let's have that debate. Let's not just
sweep the thing through."
Both the House and Senate appointed conferees who must now work
with members of the opposite chamber to resolve differences between
the two budget bills. The House conferees include: Budget Committee
Chair John Spratt (D-S.C.); Ranking Member Paul Ryan (R-Wis.); and
Reps. Allen Boyd (D-Fla.), Rosa DeLauro (D-Conn.), and Jeb Hensarling
(R-Texas). The Senate named Budget Committee Chair Kent Conrad (D-N.D.),
Ranking Member Judd Gregg (R-N.H.), and Sen. Patty Murray (D-Wash.).
The negotiators plan to hold a formal conference committee meeting
April 27.
AAMC President and CEO Darrell G. Kirch, M.D., April 23 wrote
House and Senate conferees in support of provisions relating to
health care reform, Medicare physician payments, VA research, health
professions training, and Function 550 (Health) programs. In summary,
the AAMC letter recommends that conferees include in the final conference
agreement:
- A deficit-neutral reserve fund for health care reform as proposed
under House Sec. 301 and Senate Sec. 201 without reference to "geographic
variations in spending;"
- House Sec. 314 to establish a current policy reserve fund to facilitate
replacement of the sustainable growth rate (SGR) methodology used
to calculate Medicare physician payments;
- Senate Sec. 236 to establish a deficit-neutral reserve fund to increase
health care professionals in the Veterans Health Administration;
- Senate Sec. 302(b) to exempt the Department of Veterans Affairs (VA)
medical care and research programs from points of order against advanced
appropriations;
- The $235 million for the National Health Service Corps (NHSC) as permitted
under S.Con.Res.13 and Senate Sec. 243 to establish a deficit-neutral
reserve fund to ensure this increased NHSC funding; and
- A Sense of the Congress that sufficient investments should be made
in Function 550 (Health) as called for by House Sec. 603.
The letter also notes that "in light of its significant role
in the delivery of health care, the AAMC believes that the academic
medical community must play an integral role in identifying and
implementing health care reform."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
AAMC Signs Letter Urging Reserve Fund for Medicare
Physician Payment Reform
The AAMC joined 75 specialty societies in signing an April 13 letter
urging House and Senate budget conferees to include in the final
Congressional budget resolution a provision that replaces the sustainable
growth rate (SGR) methodology with a new Medicare physician payment
system. The group recommends preserving Section 314 of the House-passed
budget resolution (H.Con.
Res. 85) in the final agreement. Section 314 of the House budget
resolution provides a reserve fund that would support Medicare physician
payment reform and avoid the 21 percent physician payment cut scheduled
for Jan. 1, 2010. The letter states that physician payment reform
is essential within the context of broad health care system reform.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
FOVA Supports Advanced Appropriations for VA Research
The Executive Committee of Friends of VA Medical Care and Health
Research (FOVA) April 22 urged
the House and Senate budget committees to preserve Section 302(b)
of the Senate-passed budget resolution (S.Con.
Res 13), which would permit advanced appropriations for the
Department of Veterans Affairs (VA) medical care and research. The
House version of the budget resolution (H.Con.
Res.85) did not include a similar provision.
The letter notes that "unpredictable and partial-year funding
with arbitrary peaks and valleys for the VA research program impedes
important VA research on national priorities," and that "VA
research administrators and investigators are understandably reluctant
to expand their research endeavors as this record of inconsistent
funding can quickly devastate plans for growth."
The FOVA Executive Committee thanked Sen. James Inhofe (R-Okla.)
for his leadership in sponsoring the VA advanced appropriations
amendment during Senate consideration, as well as the amendment's
cosponsors: Senate Veterans Affairs Committee Chair Daniel Akaka
(D-Hawaii), Ranking Member Richard Burr (R-N.C.), and Sens. John
Thune (R-S.D.) and Lisa Murkowski (R-Alaska).
House and Senate bills (H.R.
1016 and S.
423) sponsored Feb. 12 by House VA Committee Chair Bob Filner
(D-Calif.) and Chairman Akaka, respectively, would authorize advanced
appropriations for VA medical care, but not VA research.
The AAMC is a member of the FOVA Executive Committee and echoed
the FOVA support in its own recommendations (see related
story).
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Panel Holds First Health Care Reform Roundtable
The Senate Finance Committee April 21 held the first of three "roundtable"
discussions on health care reform. The discussion focused on identifying
and promoting new clinical care delivery models, as well as ways
to lower costs and improve quality and value.
President and CEO of Geisinger Health System Glenn Steele Jr.,
M.D., Ph.D., presented his system's approach to quality improvement,
reduction of readmissions, and primary care as new models of health
care delivery. He added that wide adoption of such approaches would
require additional incentives. Sen. Debbie Stabenow (D-Mich.) also
referenced the potential options for delivery system reform that
could result from the University of Michigan's participation in
the Centers for Medicare and Medicaid Services (CMS) physician group
practice demonstration program.
Re-engineering of delivery systems and increasing payments for
primary care were uniformly touted as necessary components of advancing
health care delivery. Mark McClellan, M.D., director of the Brookings
Institute's Engelberg Center for Health Care Reform, noted that
such approaches would require an up-front investment in health care
as well as expanded infrastructure resources for CMS.
Medicare Payment Advisory Commission (MedPAC) chair Glenn Hackbarth,
J.D., suggested that changes in medical education and physician
training are necessary to improve the delivery system. He identified
a specific need to boost the number of primary care providers (both
physician and non-physician). John Tooker, M.D., executive vice
president and CEO of the American College of Physicians, recommended
that primary care reimbursement levels be increased, and he publicly
lauded the AAMC's efforts to be "out front" in promoting
the "medical home" model. He also encouraged academic
medical centers to place greater value on the provision of primary
care. Both Dr. Tooker and Frank Opelka, M.D., of the American College
of Surgeons, identified the urgent need to train more physicians,
and American Hospital Association President Rich Umdenstock told
Sen. Bill Nelson (D-Fla.) that at least another 15,000 Medicare-supported
graduate medical education (GME) slots - and possibly as many as
30,000 - are necessary to meet the nation's health care needs.
Despite concerns expressed by Ranking Members Charles Grassley
(R-Iowa) and other Republicans about the "irony" of making
costly short-term investments to reduce long-term costs, Committee
Chair Sen. Max Baucus (D-Mont.) still believes that reform legislation
will advance very quickly, and said he planned to conduct a bipartisan
internal discussion of policy options the week of April 27. Two
additional roundtables, on coverage and financing, are scheduled
for May 5 and 14, respectively.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
AAMC, Coalition Comment on False Claims Act Amendments
The AAMC April 21 joined 16 organizations-including the American
Hospital Association and the Greater New York Hospital Association-in
a letter
coordinated by the U.S. Chamber of Commerce regarding the "Fraud
Enforcement and Recovery Act of 2009" (FERA, S.
386). FERA includes provisions that will amend the False Claims
Act (FCA) [see Washington Highlights,
March 6]. The letter urges adoption of an amendment offered
by Sen. Jon Kyl (R-Ariz.) to help clarify that an actionable "obligation"
does not include a contingent or potential duty to pay penalties
or fines, and that the legislation only imposes liability for knowing
and improper "retention" of an overpayment, as opposed
to mere "receipt" of an overpayment.
The Senate April 22 resumed consideration of FERA and adopted the
Kyl amendment. Sen. Bernie Sanders (I-Vt.) cast the lone vote against
the amendment. The Senate has scheduled a vote the evening of April
27 to invoke cloture, which would limit debate and require an April
28 vote on the bill.
The House Judiciary Committee is scheduled to mark-up the "False
Claims Act Corrections Act of 2009" (H.R.
1788) the week of April 27 [see Washington
Highlights, April 3].
The AAMC joined the same groups in another April 21 letter
to committee members opposing mark-up of H.R. 1788. The coalition
letter states that the current statute is working appropriately
and that new legislation is unwarranted. Reps. Dan Maffei (D-N.Y.)
and Zoe Lofgren (D-Calif.) are expected to offer and withdraw an
amendment to H.R. 1788 that would prohibit FCA suits while a process
for overpayment reconciliation is still open. This amendment language
was proposed last year when the committee considered similar legislation.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
AAMC Submits Comments on 2010 PQRI Reporting Options
The AAMC April 17 submitted a letter
in response to the Centers for Medicare and Medicaid Services' (CMS)
request for input on reporting options for the 2010 Physician Quality
Reporting Initiative (PQRI). PQRI is a program that rewards physicians
and other eligible professionals for successfully reporting quality
metrics.
The 2009 PQRI program offers nine options for successfully reporting
either by submitting data on claim forms or through data registries.
CMS is testing reporting through electronic health records (EHR).
Current PQRI reporting and measurement is evaluated at the individual
physician level; however, the Medicare Improvements for Patients
and Providers Act of 2008 (MIPPA, P.L.
110-275) requires CMS to have a process for group reporting
by 2010.
In its letter, the AAMC supports a group reporting option but stresses
that practices should determine whether to engage in group or individual-professional
reporting. According to the letter, the group reporting option should
be patient-focused, allow for a sampling methodology, and have the
minimal requirements for data submission. In addition to group reporting,
the AAMC letter supports the use of EHR reporting for 2010 and the
creation of additional reporting periods.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Hospital Associations Urge Delay or Withdrawal
of Physician Supervision for Hospital Outpatient Therapeutic Services
Policy
The AAMC and 12 hospital associations sent an April 14 letter
urging the Centers for Medicare and Medicaid Services (CMS) to withdraw
or delay a recent policy change regarding physician supervision
of hospital outpatient therapeutic services and to suspend enforcement
of the policy until alternatives are considered and hospitals are
given adequate time to comply with the policy should CMS decide
not to change it.
Included in the 2009 outpatient prospective payment system (OPPS)
final
rule, and labeled a "clarification," this policy represents
a major change for outpatient hospital therapeutic services furnished
in on-campus, provider-based departments. According to the final
rule, a physician privileged by the hospital needs to be present
in the department whenever outpatient therapeutic services are furnished
in the hospital or its outpatient departments, both on and off campus.
Given that this policy was labeled a "clarification,"
the full implications of this change were not apparent until after
the final rule was issued; thus, many affected providers missed
the opportunity to comment.
The AAMC anticipates meeting with CMS shortly to discuss the issues
raised in the letter.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
HHS Issues Guidance on PHI Breach Notification
The Department of Health and Human Services (HHS) April 17 issued
guidance
under the HIPAA privacy rule regarding notification requirements
when there is a breach of unsecured protected health information.
The guidance, required under the American Recovery and Reinvestment
Act (ARRA, P.L.
111-5), provides the means by which covered entities and their
business associates are to determine whether a breach has occurred
that will trigger notification obligations. HHS is soliciting comments
on the guidance and in particular asks for comments on the technologies
and methodologies that render protected health information unusable,
unreadable or indecipherable to unauthorized individuals. Comments
must be submitted by May 21. The AAMC plans to submit comments on
the guidance.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Senate Schedules HHS Confirmation Vote
The Senate April 23 agreed to schedule an April 28 vote to confirm
Kansas Governor Kathleen Sebelius as Secretary of Health and Human
Services, after Republicans objected to an earlier attempt to schedule
a vote. Under the agreement, the Senate will debate the confirmation
for eight hours and 60 votes will be required for final approval,
instead of the usual simple majority.
The Senate Finance Committee April 21 voted, 15-8, to approve the
nomination. Two Republicans on the panel, Senators Pat Roberts (Kan.)
and Olympia Snowe (Maine), voted with all 13 Democrats in favor
of the nomination. The Senate Finance Committee April 2 and Committee
on Health, Education, Labor, and Pensions March 31 held confirmation
hearings with Gov. Sebelius [see Washington
Highlights, April 3].
The Finance Committee also released Gov. Sebelius's response to
a series of committee members' follow-up questions for the record
[see Washington Highlights,
April 17].
AHRQ Releases Fast Facts on Patient Safety Organizations
The Agency for Healthcare Research and Quality (AHRQ) has added
a "Fast
Facts" section to the Patient Safety Organization Web
site. The Patient Safety Organizations (PSO) are designed to establish
a framework by which hospitals, physicians, and other health care
providers may voluntarily provide information on a privileged and
confidential basis, for the aggregation and analysis of patient
safety events.
The Fast Facts provide quick information and answers to common
questions regarding Patient Safety Organizations and interpretation
of the Patient Safety and Quality Improvement Final
Rule.
Information:
Jennifer Faerberg, Director, Health Care Affairs
AAMC Health Care Affairs
jfaerberg@aamc.org
(202) 862-6221
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