Washington Highlights: July 24,
2009
AAMC Letter to Speaker Pelosi Supports IOM Study of Geographic Variations in Spending
Contents
Prior Issues
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AAMC President and CEO Darrell G. Kirch, M.D., July 21 sent a letter to Speaker of the House Nancy Pelosi (D-Calif.) urging support for
House health care reform language that would help policy-makers
"better understand" the various factors that drive geographic variations
in spending. The letter specifically supports sections 1158 and
1159 in the "America's Affordable Health Choices Act of 2009" (H.R.
3200) for closely examining the reasons for spending variations
and for "holding harmless" high-spending providers "until all the
contributing factors are better understood."
Under section 1159 of the bill, the Institute of Medicine (IOM)
would be responsible for conducting an analysis of geographic variations
in per capita spending among Medicare and privately insured patients.
The IOM also would recommend "strategies for addressing variation
... by promoting high-value care" (including possible financial
incentives). Section 1158 would revise geographic adjustment factors
under Medicare. The Secretary of Health and Human Services could
make adjustments that increase payments, but could not make any
adjustments that reduced payments (a "hold-harmless" clause).
According to the letter, current research on geographic variations
"raise more questions than they answer," and the AAMC looks forward
to "working with the IOM to expand the knowledge base from which
Congress and providers can make better decisions about our nation's
investment in health and health care." It also advises the Speaker
that "the services that major teaching hospitals offer are, indeed,
costly-such as transplants, trauma care, and care of advanced breast
or cervical cancer left undiagnosed for years because of inadequate
screening."
House Democrats July 24 reportedly reached a deal with some rural
Democrats on "the outstanding issue of regional disparities
in Medicare" (see related story).
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
House Democrats Seek Compromise on Health Reform
Legislation
House Energy and Commerce Committee Chair Henry Waxman (D-Calif.)
and other Democrats July 24 announced "a significant breakthrough
in resolving the outstanding issue of regional disparities in Medicare
and therefore in the public plan," in the America's Affordable
Health Choices Act (H.R.
3200). However, according to Rep. Mike Ross, Chair of the health
task force of the fiscally conservative Blue Dog Democrats, the
Blue Dogs were not part of the deal. Though House Democratic leaders
continue to aim for House floor consideration before August, the
Senate leadership announced July 23 that the full Senate will not
vote on reform legislation until September.
The Energy and Commerce Committee July 17 and 20 briefly resumed
consideration of H.R. 3200, adopting several changes to the substitute amendment offered July 17 by Chairman Waxman [see Washington Highlights, July 17]. Scheduled sessions through
the rest of the week were postponed to accommodate ongoing negotiations
among committee members, including the Blue Dog Democrats, and with
the Democratic leadership and the White House.
To date, the Energy and Commerce Committee has agreed to 14 amendments,
including one offered by Rep. John Sullivan (R-Okla.) that directs the Secretary of Health
and Human Services (HHS) to study the amended and new programs created
under Division C (Public Health and Workforce Development) of the
legislation, and to terminate any existing program found to be duplicative
of the proposed new program. Seven Democrats joined all 22 voting
Republicans to approve the amendment, 29-27.
The committee also adopted an amended "omnibus" amendment offered
by Energy and Commerce Health Subcommittee Chair Frank Pallone (D-N.J.).
Among other items, the omnibus amendment includes provisions to:
- Authorize the HHS Secretary to award grants to establish new
or assist existing "verified" trauma centers to "further
core missions" such as 24/7 trauma care availability, reduced
overcrowding, enhanced surge capacity, education, outreach, and
coordination. Preference is given to centers in a high-demand
geographic area, that demonstrate state support or a commitment
to underserved populations, or that have at least one GME fellowship
in trauma or trauma-related specialties "for which demand
is exceeding supply";
- Establish within the HHS Office of the Assistant Secretary
for Preparedness and Response (ASPR) an Emergency Care Coordination
Center to promote and fund research in emergency medicine and
trauma care, promote partnerships, and promote local, regional,
and state preparedness;
- Establish a demonstration program under ASPR providing matching
grants to applicants that design, implement, and evaluate coordinated
emergency medical systems that allow tracking of hospital resources
(such as inpatient bed capacity, on-call specialist coverage,
and ambulance diversion status) and include region-wide systems;
and
- "Encourage" the Director of the National Institutes
of Health (NIH) through the Pain Consortium to continue and expand
basic and clinical research on pain causes and treatments, and
to require the consortium to submit to the NIH Director recommendations
on appropriate pain research initiatives to support through the
Common Fund. A newly created federal Interagency Pain Research
Coordinating Committee is to summarize advances in pain research,
identify gaps, and make recommendations to NIH and other agencies.
An earlier version of the amendment - which includes other provisions
that were stripped before committee approval - is available online.
Additional materials, including transcripts, other amendments, webcasts,
and committee-prepared summaries, also are available on the committee Web
site.
The other two House committees of jurisdiction - the Committees
on Ways and Means and Education and Labor - completed their mark
ups July 17.
Meanwhile, Senate Majority Leader Harry Reid (D-Nev.) announced
July 23 that the full Senate will not vote, as previously expected,
on its version of health care reform legislation before the Senate
recesses Aug. 7 for a month. However, the Senate Finance Committee
reportedly plans to vote on its portion of the health care reform
package before recess. The other Senate committee of jurisdiction,
the Health, Education, Labor, and Pensions (HELP) Committee, approved
its portion of the package July 15 [see Washington Highlights, July 17].
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Passes Labor-HHS-Education Appropriations
The House of Representatives July 24 approved (264-153) the FY
2010 House Labor-HHS-Education Appropriations bill (H.R.
3293, H.Rpt.111-220),
one week after the full Appropriations Committee voted to pass the
package. The committee considered a series of amendments July 17
[see Washington Highlights, July 17] before approving the
spending bill by voice vote.
National Institutes of Health (NIH): The bill provides $30.966
billion for the NIH, a $941.764 million (3.1 percent) increase over
FY 2009, and a $500 million increase over the President's request
(see related story). This funding level accounts
for a $300 million transfer from NIH to the Global Fund to Fight
HIV/AIDS, Malaria, and Tuberculosis, as well as a $500 million transfer
to NIH from the Project Bioshield Special Reserve Fund under the
Department of Homeland Security.
Health Professions: The bill provides $529.7 million for
the Title VII health professions and Title VIII nursing education
programs, a $137 million (34.9 percent) increase over FY 2009. For
Title VII, the bill provides $266.3 million, including the President's
proposed increases to the Title VII diversity, primary care, and
geriatric training programs. The Title VII total also includes a
$1.6 million increase over both FY 2009 and the President's request
for the Area Health Education Center (AHEC) program. As recommended
by the President, the bill provides $263.4 million for the Title
VIII nursing education programs, a $92.3 million or 54 percent boost,
including increases to the Title VIII Nursing Loan Repayment and
Nursing Faculty Loan programs.
National Health Service Corps (NHSC): The bill provides
$141.9 million for the National Health Service Corps, a $6.9 million
(5.1 percent) increase over FY 2009, but $27.2 million less than
the President's request.
Agency for Healthcare Research and Quality (AHRQ): The bill
provides $372.1 million for AHRQ, as provided in FY 2009 and the
President's budget request.
Children's GME: The bill provides $320 million for the Children's
Hospitals Graduate Medical Education program, a $10 million (3.2
percent) increase over both FY 2009 and the President's request.
Centers for Disease Control and Prevention (CDC): For the
CDC, the bill exceeds the President's request by $38 million and
provides $6.737 billion in program level funding, a $67 million
(1 percent) increase over FY 2009.
Bioterrorism and Emergency Preparedness: The committee more
than doubles funding within the Public Health and Social Services
Emergency Fund (PHSSEF) for the HHS Office of the Assistant Secretary
for Preparedness and Response (ASPR). The bill provides $1.644 billion
for ASPR, an $856.7 million (109 percent) increase over FY 2009,
but $510 million less than the President's request. The bulk of
the increase is achieved by fulfilling the President's request to
transfer the Project Bioshield Special Reserve Fund to ASPR from
the Department of Homeland Security; unlike the President's request,
the committee transfers $500 million from the fund to the NIH's
National Institute of Allergy and Infectious Diseases.
Also within the ASPR total, the bill boosts funding for advanced
research and development by $30 million (10.9 percent) to $305 million,
as recommended in the President's budget. The ASPR total includes
the President's recommended $49.2 million (13.3 percent) increase
for the Hospital Preparedness grants as well, with $420 million
for the program.
The Senate Labor-HHS-Education Appropriations subcommittee is scheduled
to consider its version of the spending bill July 28.
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
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House Approves Increase in FY 2010 NIH Funding
The House July 24 approved (264-153) the FY 2010 House Labor-HHS-Education
Appropriations bill (H.R.
3293). The bill provides $30.966 billion for NIH, a $941.764
million increase over FY 2009, and a $500 million increase over
the President's request. This funding level includes a $300 million
transfer from NIH to the Global Fund to Fight HIV/AIDS, Malaria,
and Tuberculosis, and a $500 million transfer to NIH from the Project
BioShield Special Reserve fund under the Department of Homeland
Security.
The House approved by voice vote an amendment offered by Rep. Darrell
Issa (R-Calif.) to prohibit NIH from funding three peer-reviewed
grants supported by the National Institute on Alcohol Abuse and
Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA)
to study alcohol and substance use and increased HIV risks among
vulnerable populations in Thailand, China, and Russia and develop
interventions to reduce AIDS transmission.
According to the committee report (H.
Rpt. 111-220) to accompany the bill, which was filed July 22,
the House Appropriations Committee rejected the Administration's
proposal to set specific funding levels for particular diseases,
saying it "is concerned by the harmful precedent established in
the Administration's budget…. The Committee believes it is more
appropriate to allocate funding in a way that permits scientific
peer review to decide the most promising research to support."
The committee report notes the bill includes resources to support
10,739 new and competing research grants, an increase of 914 over
FY 2009 (excluding the grants supported with Recovery Act funding),
and provides an average 2 percent increase for both new and continuing
grants to maintain the grants' purchasing power. The total number
of research grants will rise to 38,888 - an increase of 1,105 over
the current year.
The bill does not provide funding for one-year Bridge awards for
investigators who either are being considered for their first award
renewal or have just missed the funding payline with no other sources
of support. The committee report notes that funding provided in
the Recovery Act has already addressed this need for FYs 2009 and
2010, and the Administration did not request funding for this activity
in the FY 2010 budget.
The committee report notes the Director's Pioneer Awards "are an
effective tool to encourage high risk, transformative research"
and the bill provides $40.6 million within the Common Fund for this
purpose. The bill also continues the Transformative RO-1 Grants
program, a high risk, high reward initiative first funded through
the Common Fund in FY 2009.
The bill rejects the Administration's proposal to limit salaries
of researchers through an NIH grant to not more than the rate of
Executive Level II ($177,000 in 2008) and continues language from
previous years setting the limit at Executive Level I ($196,700
in 2009).
The bill provides a 2 percent average increase in research training
stipends - only the third stipend increase in the last six years
- and funding for two programs to support young investigators: $102
million through all the institutes and centers for the Pathways
to Independence program to provide new investigators with mentored
grants that convert into independent research project grants; and
$80 million through the Common Fund for the New Innovator awards
that provide first-time independent award funding for a five-year
period based more on ideas than experimental data.
The bill also maintains NIH's authority to transfer 1 percent of
funds made available for National Research Service Awards to the
Health Resources and Services Administration and 1 percent to the
Agency for Healthcare Research and Quality.
In addition, the bill:
- supports the Common Fund at $534.1 million as a set-aside within
the Office of the Director (OD);
- continues the National Children's Study with an appropriation
of $194.4 million;
- includes $25 million for a flexible research authority modeled
on the Department of Defense Advanced Research Projects Agency;
- provides $96.7 million through the OD for radiological, nuclear
and chemical countermeasures;
- provides up to $10 million for the Director's Discretionary
Fund to respond to unanticipated, one-time scientific opportunities;
- includes $24 million to continue a trans-NIH initiative to advance
drug development for rare and neglected diseases and combat antibiotic
resistance by leveraging the chemical genomic centers created
through the Common Fund; and
- provides $5 million for the new bioethics research and training
initiative proposed in the President's budget, but funds it throughout
the institutes and centers rather than in the OD.
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
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
HIT Standards Committee Reviews Standards for
EHR "Meaningful Use" and Certification
The Health Information Technology (HIT) Standards Committee July
21 met to discuss standards for "meaningful use" and certification
of electronic health records (EHRs). The committee was established
by the American Recovery and Reinvestment Act of 2009 (ARRA, PL
111-5) to propose standards for the policies recommended by the
HIT Policy Committee. At its July 16 meeting, the HIT Policy Committee
adopted a definition of "meaningful use" and recommended high-level
criteria for the certification process [see Washington Highlights, July 17].
The Standards Committee focused its work on what could be done
for 2011 and 2013 and heard reports from its three workgroups (Clinical
Quality, Clinical Operations, and Privacy and Security):
- The Clinical Quality Workgroup is performing a detailed review
of the performance measures recommended by the Policy Committee
for "meaningful use" and identifying where the measures may need
to be modified for EHR use. Most measures were designed for claims
reporting or chart extraction..
- The Clinical Operations Workgroup is evaluating the standards
that can be used for data collection and transmission in 2011
and 2013 and suggested directions for future standards. The Clinical
Operations Workgroup suggested allowing non-standard documents
and codes for 2011 reporting, but not by 2013. The HIT Standards
Committee had questions about how certain standards apply to individual
measures. The committee approved the high-level recommendation
for standards, but asked the Clinical Operation Workgroup to revise
how the standards apply to individual measures.
- The Privacy and Security Workgroup presented a summary of the
privacy and security requirements that relate to the eight ARRA
priority areas of focus. They also presented a matrix, which was
adopted by the committee, that rated the "maturity"
of each privacy and security standard (whether the standard can
be used in 2011, 2013, or later).
The committee also had a discussion distinguishing between the
requirements for "meaningful use" and for "certification." The committee
agreed that the "meaningful use" was on an "adoption year framework"
(per the HIT Policy Committee recommendation), but the standards
for EHRs should be based on calendar year. For example, regardless
of when a provider implements an EHR, the products themselves should
meet the 2011 standards in 2011, and the 2013 standards in 2013.
The Office of the National Coordinator of Health Information Technology
(ONC) and the Centers for Medicare and Medicaid Services (CMS) will
consider the recommendations from the two committees in drafting
regulations to be released in December.
The Standards Committee is scheduled to meet next on Aug. 20. Meeting
materials can be located at the committee's Web
site.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
House Education Committee Approves Student Loan
Reform Bill
The House Education and Labor Committee July 21 approved the Student
Aid and Fiscal Responsibility Act of 2009 (H.R.
3221), highly anticipated legislation to implement the President's
proposal to eliminate the Federal Family Education Loan (FFEL) program
[see Washington Highlights, July 17].
The committee adopted a "manager's amendment" that omits
a provision of the bill as introduced that would have terminated
the authority of the Department of Education to make interest subsidized
loans to graduate and professional students. The elimination of
these loans would have cost medical students approximately $16,000
over the life of their loans.
As passed by the committee, H.R. 3221 eliminates the FFEL program
and originates all loans after July 10, 2010, under the Direct Loan
program. A primary concern among the financial aid community is
the quality of customer service that will be offered by the Department
of Education considering the expected substantial increase in Direct
loan volume. The bill also restructures the funding structure of
the Perkins loan program and eliminates the in-school interest subsidy
for these low-interest, need-based loans. The bill also proposes
simplifications to the Free Application for Federal Student Aid
(FAFSA).
The House passed the bill after rejecting, 169-259, a substitute
amendment by Rep. Paul Ryan (R-Wis.), the ranking member of the
House Budget Committee, to establish caps on discretionary spending
from FY2010 through FY2014, impose a cap on total spending as a
percentage of gross domestic product (GDP), and place maximum limits
on federal budget deficits through FY 2019 as a percentage of GDP.
The House also defeated, 196-234, an amendment by Rep. Kind to recommit
the bill to the Budget Committee with instructions to report the
bill back to the House with an amendment inserting provisions to
impose discretionary spending caps from FY 2011 through FY 2013,
require CBO report the interest costs of legislation, and require
CBO score the cost of legislative conference reports.
It is unclear if the House will take up the measure through the
budget reconciliation process or as a stand-alone bill. The Senate
has not introduced companion legislation.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
House Passes Bill to Require Offsets for New Mandatory
Spending, Tax Provisions
The House July 22 passed, 265-166, legislation requiring the cost
of new mandatory spending programs or tax cuts be offset elsewhere
in the budget. The Statutory Pay-As-You-Go Act of 2009 (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. H.R. 2920 mandates OMB to assess the cost
of the new policies over 10 years.
When the Democrats assumed control of Congress in 2007, they instituted
procedural pay-as-you-go or "Pay-go" rules that often have been
waived. President Obama June 9 called on Congress to place the rules
in statute [see Washington Highlights, June 12].
H.R. 2920 would exempt the costs of a number of existing programs,
including preempting the annual cuts to Medicare physician reimbursement,
limiting the alternative minimum tax, and extending the 2001 and
2003 tax cuts. In a July 22 floor statement in support of passage,
House Majority Leader Steny Hoyer (D-Md.) acknowledged the "exemptions
as a crucial concession to political reality…. It is clear that
there is bipartisan support in Congress for extending those current
policies without offsetting savings."
The bill faces an uphill battle in the Senate, where Democrats,
including Budget Committee Chair Kent Conrad (D-N.D.), are far less
supportive of the proposal.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
On the Agenda in Washington...
National Advisory Council for Healthcare Research
and Quality—Advisory Committee Meeting
July 24, 9 a.m.–3 p.m., Room 800, Hubert H. Humphrey Building
National Advisory Council for Healthcare Research and Quality of
the Department of Health and Human Services meeting to report on
the Child Health Insurance Program Reauthorization Act Quality Provisions,
to issue the National Quality and Disparities Report, and to report
on the Comparative Effectiveness Research Methods Symposium.
Senate Appropriations Subcommittee on Labor, Health
and Human Services, Education, and Related Agencies Subcommittee
Markup
July 28, 2:30 p.m., 138 Dirksen Building
The Senate Subcommittee is scheduled to mark-up The Fiscal 2010
Labor-HHS-Education Appropriations draft.
Senate Special Aging Committee Hearing
July 29, 2 p.m., 562 Dirksen Building
Senate Special Aging Committee will hold a hearing titled "Medical
Research and Education: Higher Learning or Higher Earning?"
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