Washington Highlights: September
25, 2009
Contents
Prior Issues
 |
Finance Committee Takes Up Health Care Reform
Legislation
The Senate Finance Committee Sept. 22 began its mark-up of a health
care reform package, the America's Healthy Future Act. The legislation
(a "modified
mark") is an amended version of language initially released
Sept. 16 by Committee Chair Max Baucus (D-Mont.) [see Washington
Highlights, Sept. 18].
With the number of amendments
exceeding 500, the mark-up continued through Sept. 25, with the
committee scheduled to resume deliberations on Sept. 29.
The modified mark alters the chairman's mark language that would
redistribute unused residency training slots. Specifically, the
modified mark narrows from 80 to 65 percent the portion of unused
residency slots that would be eligible for redistribution. Additionally,
the modified mark narrows the eligibility criteria established in
the initial chairman's mark by reducing the number of institutions
that qualify for the redistributed slots. The modified mark directs
the redistributed slots to hospitals in the 10 states having the
fewest residents per population and greatest population living in
a health professions shortage area (HPSA).
Also, the modified mark establishes "teaching health centers"
(THCs). The language allows community-based ambulatory patient care
centers (e.g., community health centers, rural health centers, and
health care centers for the homeless) to receive Medicare payments
for direct graduate medical education expenses and "other indirect
expenses associated with operating approved graduate medical residency
training programs." The modified mark also authorizes $125
million in teaching health center development grants for fiscal
years 2010 ($25 million), 2011 ($50 million), and 2012 ($50 million).
The grants, made available under Title VII of the Public Health
Service Act, could be used to establish or expand primary care residency
programs at THCs.
The committee Sept. 24 adopted (15-3) an amendment (#10)
offered by Sen. John Rockefeller (D-W.Va.), which clarifies the
role, membership, and authority of the Medicare commission established
in the chairman's mark [see Washington
Highlights, Sept. 18].
Under the Rockefeller amendment, starting in 2014, the Commission
would be required to implement "policies that successfully
reduce cost growth in Medicare by at least 1.5 percent annually,"
but could not increase beneficiary premiums or deductibles. If such
proposals do not achieve the 1.5 percent decrease, the Secretary
of Health and Human Services would have the authority to "make
up the balance of the decrease … through a cumulative reducing
in provider reimbursement."
In anticipation of the mark-up, Sen. Orrin Hatch (R-Utah) filed
an amendment (#121)
that would add to the health care reform package AAMC-supported
legislation (H.R.
3134) establishing a "health care innovation zone"
(HIZ) demonstration project [see Washington
Highlights, July 17].
An HIZ would comprise integrated health care delivery networks that
include a teaching hospital, medical school, and a full spectrum
of other inpatient, outpatient, post-acute, and preventative services
for a designated geographic region. The amendment seeks to support
innovation through new patient-centered models of care. The amendment
also allows an HIZ to request and receive exemptions from regulatory
and other barriers to provider alignment and integration.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Len Marquez, Director
AAMC Government Relations
lmarquez@aamc.org
(202) 862-6281
MedPAC Addresses Graduate Medical Education and
Regional Variations
At its Sept. 17-18 meeting,
the Medicare Payment Advisory Commission (MedPAC) discussed
the Council on Graduate Medical Education (COGME) perspective on
medical education, as well as results of a MedPAC analysis on regional
variations in Medicare spending.
Russell Robertson, M.D., COGME Chair and Professor and Chair of
Northwestern University's Department of Family and Community Medicine,
highlighted the need to address the shortage of primary care physicians.
According to Dr. Robertson's presentation,
65 percent of all physicians in the U.S. are specialists, while
35 percent are primary care physicians. He also discussed reasons
for the imbalance in the proportion of generalists to specialists
including lack of funding for graduate medical education (GME) and
the perception, among medical students, that primary care does not
result in the same levels of both professional satisfaction and
income as other specialties.
Following the presentation, the commissioners discussed ways to
increase the level of professional satisfaction in primary care
specialties and decrease the income gap between generalists and
specialists. According to Dr. Robertson, the medical home model
holds promise, but any changes will take time to make an impact.
Many commissioners expressed interest in how regulatory barriers
can be removed to encourage training in nonhospital sites, especially
since most primary care occurs in nonhospital settings rather than
the hospital.
The commissioners also were interested in how and why some hospitals
continue to fund residency positions that exceed their caps and
discussed ways in which changes in GME policies could lead to an
increase in the number of primary care residents and a decrease
in the number of subspecialty residents.
The medical education discussion was a continuation of MedPAC's
effort to explore ways Medicare can improve medical education to
better address the needs of the population. MedPAC began to take
a closer look at this issue in October 2008 and included a chapter
on medical education in its June 2009 Report to the Congress.
In light of the increased interest by the Administration and Congress
in achieving Medicare savings by reducing regional variation in
spending highlighted by the Dartmouth Atlas study, MedPAC conducted
its own analysis.
The analysis shows that the magnitude of regional variation in service
use is lower than the magnitude of regional variation in spending,
indicating that regional differences are less dramatic than would
be suggested by looking at raw spending. Another key finding is
that both the high-use and low-use regions exhibit high growth.
MedPAC intends to produce a policy brief on this issue by mid-October
rather than develop a chapter in its annual reports to the Congress.
The purpose of the policy brief is to examine service use variations
resulting from differences in practice patterns and care decisions
and help policymakers focus on factors that can help control program
spending.
Information:
Mark Lyles, Director
AAMC Health Care Affairs
mlyles@aamc.org
(202) 828-0493
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
House Approves Continuing Resolution with Legislative
Branch Spending Bill
The House Sept. 25 approved a continuing resolution (CR) to keep
most of the federal government operating at FY 2009 funding levels
through the end of October, while Congress completes work on the
12 annual spending bills. House and Senate negotiators on the FY
2010 Legislative Branch spending bill (H.R.
2918) attached the stopgap funding measure to the bill before
approving the conference agreement Sept. 24.
To date, the House has approved all its spending bills, while the
Senate has approved five; without the continuing resolution, funding
for federal programs will expire Sept. 30. The measure provides
temporary increases for the Veterans Health Administration and the
Census during the one-month extension.
Republicans object to pairing the CR with the legislative branch
spending bill.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
House Approves SBIR Extension
The House Sept. 23 approved another short-term extension of the
Small Business Innovation Research (SBIR) program. The measure (H.R.
3614) extends the programs through Oct. 31, while House and
Senate negotiators continue to work on legislation to reauthorize
the programs.
House-passed and Senate-passed reauthorization bills differ on
whether to increase the percentage of their budgets that major federal
research agencies must devote to the SBIR program. The Senate-passed
bill (S.
1233) includes a provision to increase the allocation for the
SBIR program from 2.5 percent to 3.5 percent of any federal agency
budget that provides more than $100 million for research, including
the National Institutes of Health. AAMC opposes increasing the allocation
[see Washington Highlights,
June 26].
Originally scheduled to expire July 31, Congress approved a two-month
extension of the program on July 29 [see Washington
Highlights, July 31].
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
NIH Begins Stem Cell Line Approval Process
The National Institutes of Health (NIH) Sept. 21 announced
it is now accepting requests from owners of human embryonic stem
cell lines for approval to use in NIH-funded research. The final
NIH Stem Cell Guidelines
issued on July 7 outlined the approval process [see Washington
Highlights, July 10].
Following the submission
of requisite documentation, the NIH staff and a new working group
of the Advisory Committee to the Director will recommend whether
existing stem cell lines should be made eligible. The review largely
will center on the informed consent process used during the derivation
process.
NIH also announced the members of the new Working Group for Human
Embryonic Stem Cell Eligibility Review. Jeffrey R. Botkin, M.D.,
M.P.H., professor of pediatrics at University of Utah's School of
Medicine, will chair the panel. He is also the associate vice president
for research integrity at the University of Utah. The other members
of the working group include representatives from several AAMC member
institutions:
- Dena S. Davis, J.D., Ph.D., professor of law, Cleveland-Marshall
College of Law, Cleveland State University;
- Pamela B. Davis, M.D., Ph.D., dean of the School of Medicine,
Case Western Reserve University;
- David A. Grainger, M.D., M.P.H., director, Center for Reproductive
Medicine; associate dean for research; professor, Department of
Obstetrics and Gynecology; director, Division of Reproductive
Endocrinology; University of Kansas School of Medicine-Wichita;
- Richard P. Lifton, M.D., Ph.D., chair, Department of Genetics;
professor of genetics, medicine and molecular biophysics and biochemistry,
Yale School of Medicine; investigator, Howard Hughes Medical Institute;
- Bernard Lo, M.D., professor of medicine; director, Program
in Medical Ethics; Department of Medicine, University of California,
San Francisco;
- Terry Magnuson, Ph.D., professor and chair of the Department
of Genetics of the School of Medicine, University of North Carolina
at Chapel Hill;
- Jeffrey C. Murray, M.D., professor of neonatology and genetics;
professor of biological sciences, dentistry, and epidemiology
in the College of Public Health; Department of Pediatrics, University
of Iowa Children's Hospital; and
- Carlos Pavão, M.P.A., training and technical specialist,
Education Development Center. Inc.; member, NIH Director's Council
of Public Representatives.
Information:
Tony Mazzaschi, Senior Director
AAMC Scientific Affairs
tmazzaschi@aamc.org
(202) 828-0059
House Panel Holds Additional Health Reform Markup
The House Committee on Energy and Commerce Sept. 23 held a supplemental
markup to consider a limited number of additional amendments to
the America's Affordable Health Choices Act of 2009 (H.R.
3200), in accordance with an agreement reached by Chair Henry
Waxman (D-Calif.) and Ranking Member Joe Barton (R-Texas) before
the committee approved a modified version of the bill July
31 [see Washington Highlights,
July 31].
The committee agreed to a motion offered by Chairman Emeritus John
Dingell (D-Mich.) to send the additional adopted amendments to the
House Rules Committee for consideration as it works to combine versions
of H.R. 3200 approved by the House Committees on Ways and Means,
Education and Labor, and Energy and Commerce.
The committee also adopted a manager's
package of amendments offered by Chairman Waxman. Among other provisions,
the amendment authorizes grants and contracts for a health sciences
training program to prepare secondary school students for careers
in health professions. Another amendment,
offered by Reps. Barton, Gene Green (D-Texas), and Michael Burgess
(R-Texas) would require information transparency and plan disclosure
among states on the actual cost of Medicare and Medicaid procedures.
The committee adopted the amendment, 51-0.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
Len Marquez, Director
AAMC Government Relations
lmarquez@aamc.org
(202) 862-6281
House, Senate Panels Hold Hearings on Biosafety
Laboratories
The Government Accountability Office (GAO) Sept. 22 testified
before three Congressional committees regarding security practices
and oversight of laboratories that deal with dangerous pathogens.
Nancy Kingsbury, Ph.D., GAO managing director of applied research
and methods, testified
before the House Energy and Commerce Subcommittee on Oversight and
Investigations and the Senate Judiciary Subcommittee on Terrorism
and Homeland Security. As noted in the GAO's Sept. 21 report
on high containment laboratories, Dr. Kingsbury testified that no
single federal agency is responsible for overseeing the labs and
that a national strategy could help ensure that the number of labs
does not exceed the nation's need.
Meanwhile, the Senate Homeland Security and Governmental Affairs
Committee heard testimony
from Gregory D. Kutz, GAO managing director of forensic audits and
special investigations. The testimony focused on updates to previous
reports on perimeter security at biosafety level 4 (BSL-4) labs.
Committee Chair Joe Lieberman (ID-Conn.) and Ranking Member Susan
Collins (R-Maine) Sept. 8 introduced legislation that would expand
significantly the Department of Homeland Security's role in regulating
such research [see Washington
Highlights, Sept. 11].
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
On the Hill…
Massachusetts Gov. Deval Patrick (D) Sept. 24 named Paul Kirk,
a former Democratic National Committee chair and a former aide to
the late Sen. Edward Kennedy (D-Mass.), to fill Sen. Kennedy's seat
until a permanent replacement is named in a Jan. 19 special election.
Rep. John M. McHugh (R-N.Y.) Sept. 21 resigned from Congress, shortly
before he was sworn in at the Pentagon as the new secretary of the
Army. In his 9th term, Rep. McHugh served on the House Committee
on Oversight and Government Reform and as Ranking Member of the
Armed Services Committee.
On the Agenda in Washington
Sept. 28-29: NSF Advisory Committee Meeting
8:30 a.m.; National Science Foundation, 4201 Wilson Blvd., Arlington
Va.
The National Science Foundation (NSF) Advisory Committee will meet
to discuss activities and initiatives for the coming year for programs
of the Office of International Science and Engineering.
Sept. 29-30: National Emergency Medical Services Advisory
Council Meeting
8 a.m.; Crystal Gateway Marriott, 1700 Jefferson Davis Highway,
Arlington, Va.
National Emergency Medical Services Advisory Council of the National
Highway Traffic Safety Administration holds a two-day meeting
that includes committee reports, a discussion on emerging issues
and an H1N1 "swine flu" virus panel.
Sept. 29: Senate Small Business and Entrepreneurship Full
Committee Hearing
11 a.m.; 562 Senate Dirksen Building
The Senate Small Business and Entrepreneurship Committee is scheduled
to hold a hearing
titled "Reform Done Right: Sensible Health Care Solutions for
America's Small Businesses."
Sept. 30: The Senate Veterans Affairs Full Committee Hearing
9:30 a.m.; 418 Senate Russell Building
The Senate Committee on Veterans Affairs Committee will hold a hearing
on the Department of Veterans Affairs (VA) contracts for health
services.
Sept. 30: Rescheduled 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. 30: Senate Special Aging Committee Hearing
11 a.m.; 106 Senate Dirksen Building
The Senate Special Aging Committee
will hold a hearing on how successful health systems keep costs
low and quality high.
Oct. 1-2: Emerging Technology and Research Advisory Committee
Meeting
8:30 a.m.; 4830 Commerce Department, 1401 Constitution Ave. NW
The Emerging Technology and Research Advisory Committee of the Bureau
of Industry and Security, Commerce Department, will hold a partially
closed meeting
to discuss "deemed" export control methodology.
|
