Washington Highlights: June 19,
2009
AAMC Letters to Congress Reiterate Health Reform
Priorities
Contents
Prior Issues
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AAMC President and CEO Darrell G. Kirch, M.D., June 18 sent letters
to key Congressional leaders reiterating the AAMC positions on major
health care reform proposals of critical importance to the nation's
medical schools and teaching hospitals. The letters went to the
chairs and ranking members of the Senate Finance and HELP committees,
as well as the House Energy and Commerce, Ways and Means, and Education
and Labor Committees. Similar letters also were sent to the House
and Senate leadership.
The AAMC recommendations included:
preserve current support for the safety net until any replacements
can demonstrate improvements;
expand the physician workforce;
repeal of Medicare's Sustainable Growth Rate (SGR) used to reimburse
physicians;
improve health care delivery that facilitates health promotion and
disease prevention while providing high-quality, cost-effective diagnosis,
and treatment of illness; and
support broad innovation in delivery models that focus on patients
and improve outcomes.
The letters state, "The AAMC and its members are committed
to working with you, and we believe academic medicine must play
a pivotal role in improving health and health care and in achieving
positive changes in the health care system." The AAMC Oct.
28, 2008, released a set of principles
that should guide health care reform discussions.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Congress Begins Considering Health Care Reform
Legislation
The Senate Health, Education, Labor, and Pensions (HELP) Committee
June 17 began considering its draft health care reform legislation
in a mark-up scheduled to last through June 26 [see Washington
Highlights, June 12].
After spending the first day making opening statements, committee
members deliberated a series of amendments to quality provisions
in Title II of the bill.
Republican committee members expressed concern about the "compressed
timeframe" for bipartisan input and repeatedly cited a preliminary
Congressional Budget Office analysis
that estimates the cost at $1 trillion (over 2010-2019). The committee
adopted by unanimous consent 17 mostly Republican-sponsored amendments,
including: an amendment that clarifies the bill's definition of
"medical home"; an amendment that directs health teams
to use medical home models based on evidence-informed medicine;
an amendment that requires the Secretary of Health and Human Services
to consider unique characteristics of rural and low-volume hospitals
when developing criteria to reduce readmissions; and amendments
that make additional health professionals eligible to participate
in community health teams.
Several amendments and much of the discussion centered on the bill's
proposed "Center for Health Outcomes Research and Evaluation,"
and language indicating that the ensuing "reports and recommendations
shall not be construed as mandates for payment, coverage, or treatment."
Committee Acting Chair Chris Dodd (D-Conn.) instructed committee
staff to continue to work on a compromise that eases committee members'
concerns. The committee plans to complete amendments to Title II
by June 22, before proceeding to prevention provisions in Title
III and workforce provisions in Title IV of the bill.
Meanwhile, the House Committees on Energy and Commerce, Education
and Labor, and Ways and Means, June 19 released a discussion
draft of their joint health care reform bill. The committees are
expected to hold hearings on the legislation during the week of
June 22, with plans to consider the bills in the three committees
when Congress returns from the week-long July 4 recess.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
MedPAC Report Will Focus Future Discussions on
GME Funding
The Medicare Payment Advisory Commission (MedPAC) released its
June 2009 report
to Congress. In the report, MedPAC recognizes, "Reforming medical
education will be a key component in transforming the nation's health
care delivery system…Our medical schools and residency programs
need to emphasize a set of skills and knowledge that will equip
students and residents to practice and lead in reformed delivery
systems that work under restructured payment incentives."
In considering ways to reform health care delivery and medical
education the commission reviewed:
- the multifaceted process of becoming a practicing physician, including
the organizations involved in accreditation and certification;
- the costs and benefits for hospitals and physicians involved in teaching
and supervising residents;
- internal medicine residency programs' curricula as they relate to
health delivery systems reforms; and
- the financial disincentives and regulatory issues that discourage
residency rotations in nonhospital settings.
The report concludes that residency programs' curricula are not
well aligned with objectives of delivery system reform and financial
incentives and regulatory issues discourage nonhospital residency
experience.
The commission will focus future discussions on three main areas:
linking delivery system reforms to medical education incentives,
structuring medical education subsides to produce the professionals
we need, and enlisting other payers to contribute explicitly to
medical education.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Appeals Court Finds Medical Residents, Teaching
Hospitals Are Subject to FICA Taxes
In a June 12 decision, the U.S. Court of Appeals for the Eighth Circuit
found
that the stipends of resident physicians are subject to FICA taxes.
The court ruled against the University of Minnesota and Mayo Clinic
challenge of the IRS regulation on student exceptions from FICA (26
CFR 31.3121(b)(10)-2). The Court concluded that the IRS's regulation
was valid and that Mayo's residents did not fall within the student
exception because they worked more than 40 hours per week and were
therefore full-time employees. The ruling reverses earlier decisions
favoring the Mayo Clinic and the University of Minnesota.
While students who work for their college or university are generally
exempt from payroll taxes, there have been numerous legal battles
over whether this FICA student exception applies to medical residents.
In December 2004, following a series of judicial decisions in favor
of academic medical centers, the IRS issued new regulations on the
FICA student exception that declared medical residents to be employees
rather than students.
The District Court found the IRS regulation invalid because it
was inconsistent with the statute and was "arbitrary, capricious,
and unreasonable." The IRS appealed this decision to the Eighth
Circuit. The Appeals Court focused first on the issue of the validity
of the full-time employee limitation and concluded that the IRS's
interpretation "does not conflict with the plain language of
the statute, and is consistent with the origin and purpose of the
student exception as initially enacted. . . ." The Court noted,
"we do not rule that medical residents are not 'students' or
are not enrolled or are not "regularly attending classes"
for other purposes."
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
AAMC, NHSC Stakeholder Associations Urge Increased
Annual Appropriations
The AAMC and more than 30 health associations June 18 sent a letter
to the House and Senate Appropriations committees, urging increased
annual appropriations for the National Health Service Corps (NHSC)
in FY 2010. The AAMC-coordinated letter recommends an FY 2010 appropriation
of $235 million for the NHSC, a $111 million (89.5 percent) increase
over FY 2008 and $65 million more than the President's budget.
This recommendation follows the amount authorized for the NHSC
under the "Health Care Safety Net Act of 2008" (P.L.
110-355). The letter notes that the American Recovery and Reinvestment
Act (P.L.
111-5) provides an important boost for the NHSC, but "By
its own calculation, the NHSC falls more than 30,000 short of a
field strength that would begin to meet the needs of the nation's
underserved areas."
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
CMS Announces Registries Qualified to Submit Data
for 2009 PQRI
The Centers for Medicare and Medicaid Services (CMS) June 16 published
the list of registries eligible to submit data for professionals
in the pay-for-reporting program, Physician Quality Reporting Initiative
(PQRI). Of the 74 qualified registries, 10 are associated with academic
medical centers or AAMC Council of Teaching Hospitals (COTH) hospitals.
PQRI offers a 2 percent incentive on total allowed charges to eligible
professionals who successfully report data on quality measures to
CMS. Professionals can report the quality data codes directly through
claims or through a qualified data registry. Professionals reporting
through claims must submit the quality data code (QDC) at the time
the claim is submitted. In contrast, registries report the 2009
data to CMS in early 2010.
Registries are required to self-nominate themselves and go through
a vetting process. The number of qualified registries has more than
doubled from the 32 qualified registries in 2008, the first year
that registry reporting was an option. Several specialty societies,
regional health exchanges, electronic health record vendors, and
clinics also were qualified to submit data as data registries.
A complete list of qualified registries can be found on the CMS
PQRI Web
site.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
HIT Policy Committee Begins Debate on Definition
of "Meaningful Use"
The Office of the National Coordinator for Health Information Technology's
(ONC's) HIT Policy Committee June 16 held its second meeting to
hear reports from its three workgroups and to discuss the Meaningful
Use Workgroup's first draft
definition for "meaningful use" of certified electronic
health records (EHRs). The committee emphasized the preliminary
nature of the proposed definition and ultimately voted to return
to discussion of a revised definition at its next meeting July 16.
The draft definition, organized by the workgroup in a "Meaningful
Use Matrix,"
addresses five policy priorities:
- improving safety, quality, and efficiency;
- engaging patients and their families;
- improving care coordination;
- improving population and public health; and
- ensuring adequate privacy and security protections for personal health
information.
Incentive payments under the American Recover and Reinvestment
Act (ARRA, P.L.
111-5) would be tied to meeting the requirements set forth in
the "Measures" columns of the matrix for 2011, 2013, and
2015, respectively.
The Policy Committee also received updates from the Certification
and Adoption Workgroup, which is considering, among other questions,
who should conduct certification, what role the Certification Commission
for Healthcare Information Technology (CCHIT) should play in certification,
and how non-vendor systems should be certified. The Health Information
Exchange Workgroup also gave a brief presentation that focused on
its goal of building regional and national data exchange capacity.
As required by statute, the ONC will issue a rule by Dec. 31, 2009,
most likely in interim final form, regarding standards, implementation
specifications, and certification criteria. CMS intends to issue
a proposed rule with 60-day comment period in 2009 and a final rule
in 2010, regarding Medicare and Medicaid HIT incentive payments.
The ONC is soliciting
comments of no more than 2,000 words on the proposed definition
of "meaningful use" by June 26, 2009. Additional resources
from the Policy Committee Meeting are available on the AAMC Web
site.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
Senate Small Business Panel Increases SBIR Set-Aside
The Senate Committee on Small Business and Entrepreneurship June
18 unanimously passed legislation to reauthorize the Small Business
Administration's Small Business Innovation Research (SBIR) and the
Small Business Technology Transfer Research (STTR) programs through
Sept. 30, 2023. The programs are currently scheduled to expire July
31, 2009.
The SBIR/STTR Reauthorization Act of 2009 (S.
1233) also would increase the percentages that federal science
agencies with research budgets over $100 million a year must devote
to the SBIR and STTR programs. S. 1233 would incrementally increase
by one-tenth of a percentage point per year the percentage of their
budgets that federal science agencies such as the National Institutes
of Health (NIH) and the National Science Foundation must allocate
to the SBIR program. The allocation would be increased from the
current 2.5 percent in FYs 2009 and 2010 to 3.5 percent in FY 2020
and beyond.
As introduced June 10 by Senators Mary Landrieu (D-La.) and Olympia
Snowe (R-Maine), the chair and ranking member, respectively, of
the Senate Small Business Committee, S. 1233 included a provision
that would have exempted NIH from the increase in the SBIR allocation.
However, the "manager's amendment" approved by the committee
includes a provision added by Senator Snowe to eliminate the exemption
for NIH.
For the STTR program, the legislation would increase the percentage
from the current 0.3 percent in FY 2009 to 0.6 in FY 2015 and beyond.
The legislation also would increase the cap on SBIR awards from
$100,000 to $150,000 for Phase I awards and from $750,000 to $1
million for Phase II grants.
Legislation (H.R.
2722) to reauthorize the SBIR and STTR programs approved June
11 by the House Small Business Subcommittee on Contracting and Technology
would not increase the agency allocation for the programs. The House
bill also has been referred to the House Science and Technology
Subcommittee on Technology and Innovation.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Senate Panel Approves Spending Allocations
The Senate Appropriations Committee June 18 adopted by voice vote
its subcommittee allocations for FY 2010. The allocations, also
known as 302(b)s, limit the amount of funds each of the 12 appropriations
subcommittees have available for programs under their jurisdiction.
According to a table
released by the committee, the Senate appropriators divided $1.090
trillion in discretionary spending among the 12 subcommittees. That
number is slightly higher than the $1.086 trillion total specified
in the Congressional Budget Resolution (S.Con.Res.13)
and used by the House Appropriations Committee when it released
its allocations June 9 [see Washington
Highlights, June 12].
However, the difference is accounted for by provisions in the budget
resolution that permit an automatic increase in the discretionary
spending cap if additional funds are allocated for the Low-Income
Home Energy Assistance Program and other programs specified in the
resolution.
For the Labor-HHS Education subcommittee, the Senate allocation
is $163.1 billion, about $10.8 billion over the comparable number
for FY 2009 but $300 million less than the House allocation when
adjusted for the anticipated increases in the overall spending cap.
The Senate allocation for the Military Construction-VA subcommittee
is $76.7 billion, an increase of $3.8 billion over FY 2009 and $200
million over the House allocation.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
House Democrats Introduce PAYGO Legislation
House Majority Leader Steny Hoyer (D-Md.) June 17 introduced legislation
to implement President Obama's proposed "pay-as-you-go"
budget rules to limit increases in the federal deficit [see Washington
Highlights, June 12].
The Statutory Pay-As-You-Go Act of 2009 (H.R.
2920) is similar to a law that was in place during the 1990s
but expired in 2002. H.R. 2920 would require the Office of Management
and Budget (OMB) to determine at the end of each session of Congress
whether the overall cost of new non-emergency mandatory spending
increases or tax cuts enacted in that session has been offset by
other tax increases or spending cuts. If the new initiatives have
not been paid for, the President would be required to make an across-the-board
cut or "sequestration" of entitlement spending.
In contrast to the earlier law, which required the costs of new
spending and tax programs to be evaluated on a year-to-year basis,
H.R. 2920 would mandate OMB to assess the cost of the new policies
over 10 years. The proposed legislation also would exempt the costs
of a number of policies, including preempting the annual cuts to
Medicare physician reimbursement and extending the 2001 and 2003
tax cuts.
Although both the House and Senate already have similar "pay-as-you-go"
or PAYGO rules in place, they have been waived on a number of occasions.
A total of 156 House Democrats have co-sponsored H.R. 2920. Senate
Democrats, including Budget Committee Chair Kent Conrad (D-N.D.),
are far less supportive of the proposal.
A House Budget Committee hearing on the legislation featuring OMB
Director Peter Orszag originally scheduled for June 18 has been
postponed until June 25.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
On The Hill...
Rep. John Kline (R-Minn.) June 17 won a contest to replace Rep.
Howard P. "Buck" McKeon (R-Calif.) as the Ranking Member
on the House Committee on Education and Labor. Rep. Kline, who has
not been particularly active on higher-education issues, was considered
a front-runner for the post after several more-senior Republicans
on the committee said they would forgo the contest.
Sen. John Ensign (R-Nev.) June 17 stepped down as chair of the
Republican Policy Committee, the number 4 leadership position in
the Senate. Republican Conference Vice Chair John Thune (R-S.D.)
is expected to assume the seat.
On the Agenda in Washington...
June 25: House Budget Committee Hearing on Statutory PAYGO
10 a.m., 210 Cannon House Office Building
The House Budget Committee will hold a hearing on statutory PAYGO
(pay as you go) issues featuring OMB Director Peter Orszag.
June 22-26: Senate HELP Committee to Mark Up Health Care
Reform Legislation
Afternoon time TBA, 325 Russell Senate Office Building
The Senate Health, Education, Labor, and Pensions (HELP) Committee
is scheduled to consider the "Affordable Health Choices Act."
June 23: HIT Standards Committee to Meet
9 a.m. to 12 p.m., Omni Shoreham Hotel (2500 Calvert Street NW)
or via Web cast and teleconference
The Health Information Technology Standards Committee established
by the American Recovery and Reinvestment Act (ARRA, P.L. 111-5)
is scheduled to hold its second meeting. The meeting will be open
to the public and will include presentations by the committee's
workgroups.
June 23: House Education and Labor Committee Hearing on Health
Care Reform
Noon, 2175 Rayburn House Office Building
The House Committee on Education and Labor will hold a hearing on
the tri-Committee draft proposal for health care reform.
June 24: House Appropriations Committee Mark Up: Military
Construction and VA
Time TBA, Location TBD
The House Appropriations Committee is scheduled to mark up draft
FY 2010 appropriations for Department of Veterans Affairs (VA) Medical
Care and Research.
July 8: House Labor-HHS-Education Appropriations Subcommittee
to Mark Up FY 2010 Bill
Time TBD, Location TBD
The House Labor-HHS-Education Appropriations Subcommittee is scheduled
to consider its FY 2010 appropriations bill.
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