Washington Highlights: May 22, 2009
AAMC Comments on Finance Committee's Health Reform
Options
Contents
Prior Issues
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The AAMC May 16 and May 20 submitted comments on the first and
second of three health reform "policy options papers"
issued by the Senate Finance Committee. The three papers, as well
as public comments on the documents, will guide the panel as it
works to draft comprehensive health care reform legislation.
The initial
set of policy options focus on improving the delivery and reducing
the cost of patient care [see Washington
Highlights, April 24]. In its May 16 comments,
the AAMC applauds the committee's recognition that the physician
workforce must be expanded. However, the AAMC advises that the committee's
proposal to redistribute unused Medicare-supported graduate medical
education (GME) training slots will "fall short of what is
needed" to resolve a growing shortage of more than 100,000
physicians "in multiple specialties." To address this
significant and growing need, the AAMC strongly urges the inclusion
of the AAMC-supported
"Resident Physician Shortage Reduction Act of 2009" (S.
973/H.R.
2251) in any health reform legislation [see Washington
Highlights, May 8].
The AAMC comments also:
- Urge cautious and incremental movement toward hospital value-based
purchasing (VBP), with no more than 1 percent of hospital payments
used to reward performance;
- Commend the committee's acknowledgment that certain conditions should
be excluded from initiatives to reduce hospital readmissions. The
comments encourage the committee to consider 7-day readmission rates
(versus 30-day readmission rates);
- Advise that proposals to bundle payments for acute and post-acute
care should be fully tested and defined before being implemented.
The comments encourage similar evaluations of the "accountable
care organization" (ACO) concept included in the options paper;
- Advocate for a full repeal of the Sustainable Growth Rate (SGR),
along with implementation of a physician payment system that links
updates to an inflationary index; and
- Applaud the committee's interest in comparative effectiveness research
and support its policy option regarding greater transparency in
the relationships between physicians and manufacturers of drugs,
devices, biologicals, and medical supplies. The AAMC notes that
the committee's policy option reflects MedPAC's recommendation to
distinguish between industry payments made directly to physicians,
versus payments made to hospitals, medical schools, and universities
for sponsored research (including clinical trials).
The AAMC's May 20 comments
respond to the committee's second policy options paper,
"Expanding Health Care Coverage: Proposals to Provide Affordable
Coverage to All Americans." The paper focuses on options to
provide affordable health coverage to all Americans [see Washington
Highlights, May 15]. The AAMC comments recognize and support
the need for change, noting that the Finance Committee's coverage
objectives "align closely with those of the AAMC." However,
the AAMC states that "current programs should be supported
until we are sure that the replacements ... are better and more
rational than the systems they would be replacing." The AAMC
advises that "We must avoid the lure of terminating existing
programs" (e.g., current mechanisms that finance care for the
poor) "before new ones are proven and established."
The Finance Committee May 20 publicly released its third
and final set of policy options, which focuses on ways to finance
comprehensive health system reform. The AAMC plans to comment on
several options in the document, including a reduction in Medicare
and Medicaid support for GME, as well as cuts to Medicare and Medicaid
disproportionate share hospital (DSH) payment levels. According
to the May 20 document, the need for DSH payments decreases "as
more individuals become insured as a result of health care reform."
The document also states that another option is "to consolidate
Medicare and Medicaid payments to hospitals as a way to streamline
and better account for and coordinate funding within the DSH and
GME payment areas."
According to the three policy option papers, the proposals have
been "offered for discussion," and "not all the options
in this document have the support of Chairman Baucus or Ranking
Member Grassley." The option papers also reiterate the committee's
plan to mark-up health reform legislation in June.
Information:
Atul Grover, M.D., Ph.D., Chief Advocacy Officer
AAMC Government Relations
agrover@aamc.org
(202) 828-0410
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
President Signs FCA Amendments
The President May 20 signed
the "Fraud Enforcement and Recovery Act" (FERA, S.
386). The House May 18 passed the bill (338-52) following House
and Senate amendments to the original legislation, which primarily
addresses mortgage fraud, but also amends the federal False Claims
Act (FCA) [see Washington Highlights,
May 8]. The Senate May 14 approved the House-amended version
of the bill, while adding an additional amendment that addresses
Department of Justice subpoenas in FCA cases.
The final measure expands S. 386 as introduced, adding amendments
that were previously considered under broader FCA reform bills such
as the "False Claims Act Correction Act of 2009" (H.R.
1788) and "False Claims Act Clarification Act of 2009"
(S.
458). The House and Senate Judiciary Committees reportedly have
agreed that S. 386 will complete action on FCA legislation in this
Congress.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
AAMC Comments on HHS Proposal on Breach Notification
of Unsecured PHI
The AAMC submitted a May 21 comment letter
on guidance issued April 17 by the Department of Health and Human
Services (HHS) regarding ways to render protected health information
(PHI) secure. Such information is considered to be secure - and
therefore is not subject to breach notification requirements established
under the American Recovery and Reinvestment Act (ARRA, P.L.
111-5) - if it is protected through the methods and technologies
outlined in the HHS guidance
[see Washington Highlights, April
24].
The AAMC comment letter:
- Calls for consistency between the principles that guide requirements
for breach notification of unsecured protected health information
and those in the HIPAA Security regulation;
- Agrees with the HHS proposal that following the guidance should
be the equivalent of a safe harbor; and
- Strongly supports the proposal that PHI in limited data set form
should be treated as unusable, unreadable, or indecipherable.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
ONCHIT, CMS Release HIT Implementation Plans
The Office of the National Coordinator for Health Information Technology
(ONCHIT) and the Centers for Medicare and Medicaid Services (CMS)
May 18 released their work plans for implementing the health information
technology (HIT) provisions of the American Recovery and Reinvestment
Act (ARRA, P.L.
111-5). The CMS plan is clear that in 2010, the agency will
finalize payment incentive policies. The agency plan also states
that Medicare hospital incentives will be paid no sooner than Oct.
2010, Medicaid hospital incentives will be paid no sooner than Jan.
2011, and Medicare and Medicaid physician incentives will be paid
no sooner than Jan. 2011. Both plans suggest that meeting ARRA-imposed
deadlines will be a challenge.
ONCHIT's plan
sets forth a funding table that allocates roughly $24 million to
enhancing privacy and security (including $9.5 million for audits
by the Office for Civil Rights and CMS), $20 million to the National
Institute of Standards and Technology (NIST) to test technical standards
and establish a conformance testing infrastructure, and $300 million
for a regional HIT exchange. ONCHIT indicates that it will issue
extensive regulations regarding the HIPAA Privacy Rule on Feb. 18,
2010. No specific timeline is given for the release of a definition
of "meaningful use" of an electronic health record (EHR).
The plan also indicates that providers that receive grants or contracts
can expect the HHS Office of Inspector General (OIG) to perform
audits to ensure their financial stability and that they have auditable
financial systems.
The CMS plan
sets forth a funding table that allocates approximately $23 billion
to Medicare incentives, $21.6 billion to Medicaid incentives, $1
billion to State Medicaid administration, and $1 billion to CMS
administrative costs. The plan suggests that the development of
an infrastructure for health information exchange may take place
at the state level (CMS's list of the types of programs and activities
eligible for Medicaid Administrative funds to the States includes
developing an infrastructure for health information exchange). CMS
also indicates that the agency is planning extensive provider education
and outreach efforts regarding the incentive payment programs.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
Senate Subcommittee Holds Hearing on NIH FY 2010
Budget
The Senate Appropriations Subcommittee on Labor, Health and Human
Services, and Education May 21 held a hearing to discuss the Administration's
FY 2010 budget for the National Institutes of Health (NIH). NIH
Acting Director Raynard Kington, M.D., Ph.D., and three institute
directors (Anthony Fauci, M.D., Director of the National Institute
of Allergy and Infectious Diseases, Elizabeth Nabel, M.D., Director
of the National Heart, Lung and Blood Institute, and John Niederhuber,
M.D., Director of the National Cancer Institute) testified before the panel. In addition to the FY 2010 budget, the group discussed
the American Recovery and Reinvestment Act (ARRA, P.L.
111-5), comparative effectiveness research (CER), and conflicts
of interest (COI).
Much of the hearing focused on ARRA funding, and the possibility
of NIH "falling off a cliff" when that funding ends in
FY 2011. Dr. Kington spoke about the research community's overwhelming
response to ARRA grant opportunities, such as the newly created
Challenge Grants and Grand Opportunity (GO) grants [see Washington
Highlights, March 27].
He anticipates NIH spending more on these funding opportunities
than originally proposed.
Subcommittee Chair Tom Harkin (D-Iowa) asked the witnesses what
their reaction would be if NIH were granted an extension to ARRA
funding and given four years instead of two. All stated that NIH
would be able to spend the funds responsibly in two years, but would
appreciate the flexibility given with extra time. Chairman Harkin
suggested this might be a solution to softening the cliff that NIH
likely will face when ARRA funding runs out.
The President's budget directs a significant portion of the proposed
increase to NIH in FY 2010 to cancer and autism research. Chairman
Harkin expressed his concern that this specification does not leave
adequate money for critical research on other diseases. Dr. Kington
testified that both are important public health concerns that must
be addressed, and that additional research into these areas also
will lead to basic advances for all diseases.
The panel also discussed CER and COI. Dr. Nabel noted that an NIH
committee is currently looking into opportunities for spending the
CER money in ARRA. The NIH CER committee is considering payline
expansions and supplements for clinical trials, and anticipates
CER related applications for Challenge and GO Grants. Additionally,
a CER committee at the Department of Health and Human Services (HHS)
is looking into a uniform definition of CER to use across the department.
Regarding conflicts of interest, Chairman Harkin expressed his
concern that an NIH official recently was quoted as saying NIH may
not change its policies regarding COI, despite the HHS efforts in
this area. Dr. Kington expressed NIH's commitment to objective,
high quality research, and welcomed the opportunity to strengthen
NIH's policies and oversight system.
Information:
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
House Education Committee Examines Student Loan
Reform
The House Committee on Education and Labor May 21 held a hearing
titled "Increasing Student Aid through Loan Reform." The
committee examined President Obama's FY 2010 budget proposal, which
would end the Family Federal Education Loan (FFEL) program that
provides subsidies to private lenders for federally-insured ("guaranteed")
student loans. The President's proposal assumes the federal Direct
Loan program would originate all future Stafford loans and redirects
savings to other student aid [see Washington
Highlights, May 8].
In his opening statement, House Education Committee Chair George
Miller (D-Calif.) stated that "the economic crisis has exposed
serious vulnerabilities in the current FFEL structure," and
"FFEL is on life support."
Robert Shireman, Deputy Under Secretary, Department of Education,
testified that through the department's FFEL purchase authority,
FFEL participation interest purchase, conduit programs, and Direct
Loans, the "2010 Budget estimates that the Federal government
will finance nearly three quarters of all student loans in both
2009-2010 and 2010-2011 academic years" without any changes
to current policy. Additionally, Mr. Shireman indicated that in
the future, Direct Loan servicers will be assessed based on default
prevention and customer satisfaction to determine their proportionate
share of the federal student loan portfolio.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
CMS Seeks Feedback on ICD-9 and ICD-10 Transition
The Centers for Medicare and Medicaid Services (CMS) May 19 hosted
a national provider conference call to provide information on ICD-10-CM/PCS
implementation and General Equivalence Mappings (GEMs), a data conversion
tool designed to aid in converting applications and systems from
ICD-9 to ICD-10.
The final regulation allows health plans and providers until Oct.
1, 2013, to adopt and implement ICD-10-CM (diagnosis) and ICD-10-PCM
(procedure) codes. ICD-9 codes will not be accepted for services
provided on or after the Oct. 1, 2013, deadline.
CMS staff request feedback from providers on whether ICD-10 and/or
ICD-9-CM codes should be frozen prior to final implementation of
ICD-10, and if so, when the freeze should be instituted. Public
comments should be sent to CMS via a form
on the CMS Web site. Feedback will be discussed at the Sept. 16,
2009, meeting of the CMS ICD-9 Coordination and Maintenance Committee.
To assist in the conversion of coding data, CMS staff provided
call participants with an overview of GEMs, created by CMS and the
Centers for Disease Control and Prevention (CDC) to assist in converting
policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS.
More information about the ICD-10 transition and GEMs can be found
online.
Information:
Will Dardani, Constituent Services Specialist
AAMC Health Care Affairs
wdardani@aamc.org
(202) 828-0541
HIT Policy and Standards Committees Hold First
Meetings
Two committees established by the American Recovery and Reinvestment
Act (ARRA, P.L.
111-5) to advise the Office of the National Coordinator for
Health Information Technology (ONCHIT) held their inaugural meetings.
Together, the two committees will develop recommendations regarding
how providers can demonstrate "meaningful use" of health
information technology (HIT) to be eligible for federal Recovery
Act funding [see Washington
Highlights, May 8]. The committees also will make recommendations
for other issues related to the nation's HIT infrastructure.
The HIT Policy Committee
met May 11 and decided to form three working groups dedicated to
(1) certification and adoption; (2) meaningful use; and (3) health
information exchange. HIT National Coordinator David Blumenthal,
M.D., M.P.P., chairs the Policy Committee [see Washington
Highlights, April 10].
The HIT Standards Committee met May 15 and formed three working
groups to focus on (1) clinical operations; (2) clinical quality;
and (3) privacy and security. Healthcare Corporation of America's
Chief Medical Officer Jonathan Perlin, M.D., serves as the Standards
Committee's chair and John Halamka, M.D., M.S., serves as the committee's
vice chair. Dr. Halamka is Chief Information Officer (CIO) of the
CareGroup Health System, and CIO and Associate Dean for Educational
Technology at Harvard Medical School.
The Standards Committee
will receive direction for action through Policy Committee recommendations,
but to begin work immediately, the Standards Committee agreed to
work within "contingencies" of options the Policy Committee
is likely to recommend. The Standards Committee decided to hold
itself to a 90-day timeline for responding to Policy Committee recommendations,
though committee members recognized the need to act more quickly
in the initial stages.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
Groups Discuss Public Health Workforce
AAMC Chief Academic Officer John Prescott, M.D., May 21 participated
in a panel discussion before Congressional staff and other attendees
on the preparedness of the public health workforce to deal with
H1N1 influenza. At the event, organized by the Association of Schools
of Public Health (ASPH), Dr. Prescott stressed the role that physicians
play in public health and highlighted ongoing activities at the
AAMC and its member institutions to promote public health awareness
among aspiring and practicing physicians. Dr. Prescott also noted
that federal support for public health workforce development, such
as the Title VII health professions training programs, has been
unreliable.
Linda Rosenstock, M.D., M.P.H., Dean, UCLA School of Public Health,
and Chair of the ASPH Board of Directors, moderated the session.
Other panelists included: Georges Benjamin, M.D., FACP, FACEP, Executive
Director, American Public Health Association; Robert Pestronk, M.P.H.,
Executive Director, National Association of County and City Health
Officials; and Daniel Sosin, M.D., M.P.H., FACP, Acting Director,
Coordinating Office for Terrorism Preparedness and Emergency Response,
Centers for Disease Control and Prevention.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
President Names CDC Director, Senate Confirms
FDA Head
The President May 15 appointed
New York City Health Department Commissioner Thomas Frieden, M.D.,
M.P.H., as head of the Centers for Disease Control and Prevention
(CDC). Dr. Frieden, who served at CDC between 1990 and 2002, received
his M.D. and M.P.H. degrees from Columbia University and completed
infectious disease training at Yale University. The position does
not require Senate confirmation, and according to the President's
announcement, Dr. Frieden will assume his new role at the CDC in
early June.
The Senate May 18 voted unanimously to confirm Margaret "Peggy"
Hamburg, M.D., as Commissioner of the Food and Drug Administration
(FDA). Dr. Hamburg served as the Nuclear Threat Initiative's founding
Vice President for the Biological Program; Assistant Secretary for
Planning and Evaluation at the Department of Health and Human Services;
New York City Health Commissioner; and as the Assistant Director
of the NIH's National Institute of Allergy and Infectious Diseases.
She earned her M.D. from Harvard Medical School and completed her
training at the New York Hospital/Cornell University Medical Center.
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