Washington Highlights: September
18, 2009
Contents
Prior Issues
 |
Baucus Releases Chairman's Mark of Health Care
Reform Package
Senate Finance Committee Chair Max Baucus (D-Mont.) Sept. 16 released
the "chairman's mark" of a health care reform package,
the America's Healthy Future Act of 2009. Chairman Baucus has scheduled
a Sept. 22 mark-up of the $856 billion legislation, which he stated
is a "balanced, common-sense package that... doesn't add a
dime to the deficit."
To partially offset the costs of expanding health care coverage
to an estimated 94 percent of Americans, the mark would implement
Medicare and Medicaid payment reductions, including:
- Reductions in market basket updates for inpatient and outpatient
hospitals and other facilities ($106 billion over 10 years);
- If certain coverage expansion targets are achieved, reductions
in Medicare and Medicaid Disproportionate Share Hospital (DSH)
payments ($22.9 billion and $24.9 billion over 10 years, respectively);
- Payment reductions for hospitals with high readmission rates,
with certain readmissions excluded from the calculation ($2.1
billion over 10 years); and
- Payment reductions for hospitals with high rates of hospital-acquired
conditions ($1.2 billion over 10 years).
Several of these reductions were agreed to earlier this year during
negotiations by Chairman Baucus, the Administration, the American
Hospital Association and others [see Washington
Highlights, July 10].
The chairman's mark includes several provisions of particular interest
to medical schools and teaching hospitals, including AAMC-supported
language that would address problematic regulatory barriers to placing
residents in non-hospital settings for a portion of their training.
It also includes AAMC-supported provisions that would preserve and
distribute graduate medical education (GME) training slots when
teaching hospitals close. Additionally, the chairman's mark would
redistribute unused GME slots with preference given to teaching
hospitals using the slots to expand training programs in primary
care and general surgery. However, Medicare's indirect medical education
(IME) adjustment for the redistributed slots would be reduced by
50 percent. The GME provisions are estimated to cost $1 billion
over 10 years.
Also of particular interest to the AAMC membership are provisions
that would establish a 0.5 percent update for Medicare's calendar
year 2010 physician payments, thereby averting (for one year) a
scheduled reduction of over 21 percent at a cost of nearly $11 billion
over ten years. The mark would also establish a five-year, 10 percent
bonus payment for certain evaluation and management (E&M) services
provided by primary care practitioners. The services would have
to represent at least 60 percent of the services provided by the
practitioners. However, one-half of the bonus payments would be
funded by an across-the-board reduction in Medicare payments for
all other physician services (excluding services provided in a health
professions shortage area). In addition, the legislation would establish
a 1 percent payment reduction for physicians who do not participate
in the Physician Quality Reporting Initiative (PQRI) in 2012.
The chairman's mark would save $22.6 billion over ten years by
establishing a new independent commission to develop and submit
to Congress proposals that extend the solvency, reduce the rate
of spending, and improve the quality of the Medicare program. The
proposals would be implemented unless Congress passes an alternative
measure that achieves similar levels of Medicare savings. Additionally,
the legislation would establish a budget-neutral value-based purchasing
program for hospital in 2013 and it would require drug and medical
device manufacturers to report payments to physicians and teaching
hospitals.
Upon release of the health care reform package, the Committee's
ranking member Sen. Charles Grassley (R-Iowa) expressed
concern that the Republicans were being "pushed aside by the
Democratic leadership so the Senate can move forward on a bill that,
up to this point, does not meet the shared goals for affordable,
accessible health coverage that we set forth when this process began."
He added that "legislation that impacts every American should
have strong bipartisan support."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
House Democratic Steering and Policy Committee
Holds Forum on Health Care Reform
The House Democratic Steering and Policy Committee Sept. 15 held
a forum
to discuss the urgent need for comprehensive health insurance reform.
Testifying before the committee, Tom Priselac, AAMC past-Chair and
current American Hospital Association (AHA) Chair and president
and CEO of Cedars-Sinai Medical Center, emphasized the importance
of "protecting graduate medical education (GME) including indirect
medical education (IME) adjustments" to train the next generation
of doctors.
In her opening remarks,
Speaker of the House Nancy Pelosi (D-Calif.) expressed her thanks
to the Democratic Steering and Policy Committee Co-Chairs Reps.
George Miller (D-Calif.) and Rosa DeLauro (D-Conn.). She continued,
"We are determined in the legislation that what we are putting
together will lower costs, improve quality, expand coverage, and
make sure that people still have a choice of what they have now."
Additional panelists included Karen Davis, president of the Commonwealth
Fund; John Arensmeyer, CEO of the Small Business Majority; Jacob
Hacker, Stanley B. Resor Professor of Political Science, Yale University;
J. James Rohack, M.D., president of the American Medical Association
(AMA); Mary A. Maryland, Ph.D., MSN, APN, BC, board member of the
American Nurses Association; Wendell Potter, former communications
vice president and spokesperson for CIGNA; and Bonnie Cramer, chair
of the AARP Board.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Passes Student Loan Reform Bill
The House of Representatives Sept. 17 passed
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].
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).
During mark-up, the committee adopted a "manager's amendment"
that omitted 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. [see Washington
Highlights,
July 24].
The Senate Health Education Labor and Pensions Committee has not
considered companion legislation, but is expected to begin taking
action as soon as the week of Sept. 21.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
HIT Standards Committee Adopts Privacy and Security
Recommendations
The Health Information Technology (HIT) Standards Committee Sept.
15 heard update presentations from three of its workgroups and adopted
recommendations from the committee's Privacy and Security Workgroup.
Many of the issues raised by the three workgroups pointed toward
the need for the recently-chartered fourth workgroup on implementation
guidance. The Standards Committee makes its recommendations in an
effort to inform the Office of the National Coordinator for Health
Information Technology (ONC) and the Centers for Medicare and Medicaid
Services (CMS) rulemaking process.
The Privacy and Security Workgroup reformatted its prior recommendations
for clarity and included ideas on implementation guidance. The revised
recommendations accepted by the full committee:
- incorporate the technical requirements from the HIPAA privacy
and security rule (as amended by ARRA) into the baseline 2011
requirements for electronic health record (EHR) incentive payments;
- clarify where options are required jointly and where the implementer
is given a choice among options; and
- include high-level certification criteria statements.
The committee also indicated that its new Implementation Workgroup
will address issues including gaps in standards and implementation
guidance, complexity and barriers for implementers, and how to overcome
these barriers.
The meeting agenda and all slide presentations from the workgroup
presentations are available on the HIT Standards Committee Web
site. A more detailed summary of the meeting is available on
the AAMC HIT Web
page.
Information:
Morgan Passiment, Director
AAMC Information Resources Outreach
mpassiment@aamc.org
(202) 828-0476
CMS Proposes ESRD Bundled Payment System
The Centers for Medicare and Medicaid Services (CMS) Sept. 14 released
a proposed rule to establish a new prospective payment system (PPS)
for dialysis services for Medicare beneficiaries with end-stage
renal disease (ESRD). The rule is scheduled to be published in the
Sept. 29 Federal
Register, and if finalized, will take effect for dialysis
services furnished on or after Jan. 1, 2011.
Under the rule, CMS proposes to make a single bundled payment to
dialysis facilities that would cover outpatient dialysis treatment,
prescription drugs, and clinical laboratory tests. This new payment
system would replace the current "composite rate" ESRD
payment, which does not include certain ESRD-related items and services
such as injectable drugs and non-routine laboratory testing. CMS's
proposed base payment of $198.64 per dialysis session would be adjusted
for case-mix factors such as the patient's age, gender, body size,
and time on dialysis, as well as for facility characteristics including
area wage index and low dialysis volume. Additional adjustments
to the base payment also would be made for specific conditions or
co-morbidities that significantly affect a course of treatment,
and outlier payments would be made for particularly expensive cases.
The Medicare Improvements for Patients and Providers Act of 2008
(MIPAA, P.L.
110-275) required CMS to establish a fully-bundled ESRD PPS
and to phase the new payment system in over a four-year period.
CMS's proposal incorporates the required phase-in but also would
allow facilities to choose to be paid entirely under the new system
beginning Jan. 1, 2011.
Comments on the proposed rule are due Nov. 16, 2009.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
GAO Releases Report on Medicaid Preventive Services
The Government Accountability Office (GAO) Sept. 14 released a
report titled
"Medicaid Preventative Services: Concerted Efforts Needed to
Ensure Beneficiaries Receive Services." According to a press
release, Senate Finance Committee Chair Max Baucus (D-Mont.)
requested the report as a follow-up to a similar 2001 GAO study
"to assess the effectiveness of state Medicaid programs in
getting important care to beneficiaries."
Although GAO indicates that progress has been made since the 2001
study, the report recommends that the Centers for Medicare and Medicaid
Services (CMS) "ensure regular reviews of preventative care
services and expedite its efforts to provide states with guidance
on covered benefits."
In his press release, Chairman Baucus expressed his commitment
to continue making necessary improvements to the system, "to
passing health care reform that will increase our focus on wellness
and prevention throughout the health care system," and to "continue
working with CMS to ensure all Medicaid beneficiaries have greater
access to necessary preventative care."
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Rep. Barton Requests GAO Study of NIH ARRA Funds
House Energy and Commerce Committee Ranking Member Joe Barton
(R-Texas) sent a Sept. 11 letter
asking the Government Accountability Office (GAO) to examine the
National Institute of Health (NIH)'s use of funding provided for
medical research in the American Recovery and Reinvestment Act (ARRA,
P.L.
111-5).
The letter requests information "on the process and criteria
used for awarding grants that were made available through ARRA monies,
and the extent to which these may have varied from the process and
criteria typically used by NIH to award grants." Additionally,
the letter asks for estimates of the number of jobs created or preserved
with Recovery Act funds. In the letter, Rep. Barton requests an
"interim briefing focused on how the 2009 grants were awarded,"
as well as a final report including job estimates once all ARRA
awards are made.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
Status of HHS Spending Bill Uncertain
The Senate has not scheduled time for consideration of the FY
2010 Labor-HHS-Education Appropriations bill (H.R.
3293) amid rumors the bill may not come to the Senate floor.
The Senate has passed five of the 12 annual spending bills, approving
the Transportation bill (H.R.
3288) Sept. 17, and has begun work on the Interior bill (H.R.
2996).
The Senate Appropriations Committee passed the Labor-HHS bill
July 30 [see Washington
Highlights,
July 31]. The House passed its version of the bill July 24 [see
Washington
Highlights,
July 24].
Senate Appropriations Committee Chair Daniel K. Inouye (D-Hawaii)
Sept. 15 told reporters that he expects the Interior-Environment,
Defense, and Military Construction-VA (S.
1407) appropriations bills, in that order, to come to the Senate
floor after the Transportation-HUD bill, which the Senate passed
Sept. 17.
Obama Names National Medal Of Science Recipients
President Obama Sept. 17 named
nine researchers as recipients of the National Medal of Science,
the highest honor bestowed by the United States government on scientists.
The National Medal of Science was created by statute in 1959 and
is administered for the White House by the National Science Foundation.
Nominees are selected by a committee of Presidential appointees
based on their advanced knowledge in, and contributions to, the
biological, behavioral/social, and physical sciences, as well as
chemistry, engineering, computing, and mathematics.
"These scientists, engineers and inventors are national icons,
embodying the very best of American ingenuity and inspiring a new
generation of thinkers and innovators," President Obama said.
"Their extraordinary achievements strengthen our nation every
day-not just intellectually and technologically but also economically,
by helping create new industries and opportunities that others before
them could never have imagined."
Among others, this year's recipients include:
- National Institutes of Health (NIH) Director Francis Collins,
M.D., Ph.D.;
- J. Craig Venter, Ph.D., chair and president of the J. Craig
Venter Institute;
- Michael Posner, Ph.D., Professor Emeritus at the University
of Oregon and Adjunct Professor at Weill Cornell Medical College;
- JoAnne Stubbe, Ph.D., Novartis Professor of Chemistry and Professor
of Biology, Massachusetts Institute of Technology;
- Elaine Fuchs, Ph.D., Rebecca C. Lancefield Professor; Investigator,
Howard Hughes Medical Institute Laboratory of Mammalian Cell Biology
and Development, The Rockefeller University; and
- Dr. Joanna Fowler, a senior chemist at the U.S. Department of
Energy's Brookhaven National Laboratory, director of Brookhaven's
Center for Translational Neuroimaging, and adjunct professor in
Chemistry and Biomedical Engineering at Stony Brook University.
The recipients will receive their awards on October 7 at a White
House ceremony.
On the Agenda in Washington
Sept. 22: Senate Finance Committee Health Care Reform Markup
9 a.m.; 216 Senate Hart Building
The full Senate Finance Committee is scheduled to markup
its version of draft comprehensive health care revision legislation.
Sept. 22: Senate Judiciary Subcommittee on Terrorism and
Homeland Security Hearing
2:30 p.m.; 226 Senate Dirksen Building
The Senate Judiciary Subcommittee on Terrorism and Homeland Security
will hold a hearing
titled "Strengthening Security and Oversight at Biological
Research Laboratories."
Sept. 23-24: NIH Scientific Management Review Board Advisory
Committee Meeting
8 a.m.; Building 60, Chapel and Lecture Hall, NIH, 9000 Rockville
Pike, Bethesda, Md.
Working groups of the National Institutes of Health (NIH) Scientific
Management Review Board will the first among a series of sessions
for gathering information on the agency's organizational structure
and recommendations for enhancing the NIH mission through greater
agency flexibility and responsiveness.
Sept. 23: Senate HELP Committee Ryan White AIDS Act Reauthorization
Markup
10 a.m.; 430 Senate Dirksen Building
The full Senate Committee on Health, Education, Labor and Pensions
will hold an executive session to markup
the Ryan White AIDS Act Reauthorization.
Sept. 24: House Science and Technology Subcommittee on Technology
and Innovation Hearing
10 a.m.; 2318 Rayburn House Office Building
The House Science and Technology Subcommittee on Technology and
Innovation will hold a hearing
titled "The Potential Need for Measurement Standards to Facilitate
the Research and Development of Biologic Drugs."
|
