Washington Highlights: October 16,
2009
Contents
Prior Issues
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Finance Committee Passes Health Care Reform Bill
The Senate Finance Committee Oct. 13 approved (14-9) its health
care reform legislation,
the America's Healthy Future Act. Sen. Olympia Snowe (Maine) was
the only Republican to vote for the bill. Upon adoption, Committee
Chair Max Baucus (D-Mont.) called the $829 billion legislation a
"balanced, common-sense bill" that will improve the "efficiency,
quality, and coordination" of health care.
Shortly after the vote, Sen. Majority Leader Harry Reid (D-Nev.)
began meeting with Chairman Baucus, Sen. Chris Dodd (D-Conn.), and
senior White House officials to negotiate a merger of the health
care reform bills passed by the Finance Committee and the Health,
Education, Labor, and Pensions (HELP)
Committee. Sen. Dodd chaired the HELP Committee during the drafting
and mark-up of its health reform bill, the "Affordable Health
Choices Act" (S.
1679).
Prior to the Finance vote, the AAMC sent an Oct. 8 letter along
with the College of American Pathologists, Association for Molecular
Pathology, Association of Pathology Chairs, and the American Society
for Investigative Pathology urging Senate leadership them to drop
or significantly modify an amendment sponsored by Sen. Ron Wyden
(D-Ore.). The amendment, which was accepted by the Finance Committee,
would change current law with respect to payment for certain molecular
laboratory tests.
The Wyden provision would allow a select group of independent laboratories
to bill Medicare directly within 14 days of the patient's discharge
rather than through its existing DRG. Hospital-based laboratories,
medical schools, and teaching hospitals would not qualify, even
if they were performing the very same tests or a less costly but
equally effective alternative. These laboratories would continue
to be subject to the 14-day rule, creating the same barriers to
testing and payment that the amendment seeks to address.
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
AAMC Supports Medicare Physician Payment Legislation
AAMC President and CEO Darrell G. Kirch, M.D. sent an Oct. 15
letter of
support for legislation that repeals Medicare's problematic Sustainable
Growth Rate (SGR) methodology. Introduced Oct. 14 by Sen. Debbie
Stabenow (D-Mich.), the Medicare Physician Fairness Act of 2009
(S.
1776) also provides a foundation for further action on physician
payment reform by setting a new budget baseline in 2010 that fully
eliminates the 21.5 percent SGR deficit ($245 billion over 10 years).
Under S.1776, future updates will be set at 0.0 percent, thereby
preventing additional cuts during the development and implementation
of a new payment formula. The bill does not preclude Congress (or
a new formula) from replacing the freeze with positive updates.
Majority Leader Harry Reid (D-Nev.) expects the full Senate to
consider S. 1776 during the week of Oct. 19. The cost of S. 1776
was assumed in President Obama's budget. Since the bill does not
offset the cost of repealing the SGR and halting physician payment
cuts, at least 60 Senators must agree to waive budget rules before
a final vote. Budget Committee Chair Kent Conrad (D-N.D.) has indicated
that he could not support such an approach.
In its letter of support, the AAMC praised S. 1776 as an "important
first step toward achieving a more rational, consistent update methodology
that appropriately reimburses physicians for their services."
The letter also reiterated the AAMC's position that financing physician
payment relief "through Medicare cuts that adversely affect
medical schools or teaching hospitals would be self-defeating and
unacceptable."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
MedPAC Continues Graduate Medical Education Discussion
At its Oct. 8-9 meeting,
the Medicare Payment Advisory Commission (MedPAC) continued its
discussion on how Medicare payment policy might be used to support
the types of medical education changes that would advance and support
delivery system reforms. MedPAC included a chapter on this issue
in its June 2009 Report to the Congress and commission recommendations
are likely to be included in MedPAC's June 2010 report.
The commission heard a staff presentation that highlighted three
areas for discussion: physician pipeline issues, delivery system
reform issues, and economic inefficiencies. According to MedPAC
staff, Medicare is not the best venue to address pipeline issues
due to its focus on residency training; however, Medicare could
funnel medical education funds into programs that more directly
affect the specialty mix and practice location. To address some
of the delivery system reform issues, staff suggested Medicare could
provide incentives for graduate medical training to occur in "optimal
training environments," where residents learn the skills to
provide high-quality and efficient care. MedPAC staff also stated
that there are "economic inefficiencies" because Medicare
pays teaching hosptials indirect medical education (payments) that
are above the so-called "empirical level."
At the end of the session, MedPAC Chair Glenn Hackbarth, J.D.,
provided his summary of the discussions and his views about what
MedPAC should, and should not, focus on. He opined that MedPAC might
not want to address the resident caps, specialty mix, or curriculum
issues. He also stated that the commission might not want to take
on the issue of all payer funding of medical education.
Chairman Hackbarth suggested that the commission could focus on
"how we can get better output for the Medicare dollars about
the [IME] empirical level." MedPAC staff also may look into
whether funds should continue to go to the hospital general fund
or directly to the residency programs, especially since this issue
has led to disagreements among commissioners. In addition, Chairman
Hackbarth expressed concern that continuing to tie Medicare payments
to inpatient Medicare volume may not be the best way to address
society's needs. Instead, he suggested that they can "be tied
to the ability of programs to develop rich ambulatory environments
to train their physicians."
Other sessions at the MedPAC meeting focused on:
- Provider consolidation and prices;
- Future work on the accuracy of pricing of services in the physician
fee schedule;
- Exploring the in-office ancillary exception to the physician
self-referral; and
- Case studies and metrics for high performing systems.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
CBO Releases Analysis on "Tort Reform"
The Congressional Budget Office (CBO) Oct. 9 released an analysis
of the "effects of proposals to limit costs related to medical
malpractice (tort reform)" at the request of Sen. Orrin Hatch
(R-Utah). The report found that implementing a set of proposals
(e.g., a $250,000 cap on awards for noneconomic damages and a $500,000
cap on awards for punitive damages) would reduce federal budget
deficits by roughly $54 billion over the next 10 years and total
mandatory health care spending by roughly $41 billion over 10 years.
Further, CBO estimates that, if enacted, the set of proposals also
would reduce total national premiums for medical liability insurance
by about 10 percent.
In a press
release, Sen. Hatch said, "I think this response from the
CBO confirms that there is a growing problem regarding the costs
of health care lawsuits." Continuing he stated, "I think
that this is an important step in the right direction and these
numbers show that this problem deserves more than lip service from
policy-makers."
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
HIT Standards Committee Identifies Gaps, Announces
Opportunity for Public Comment on Implementation Issues
The Health Information Technology (HIT) Standards Committee Oct.
14 heard update presentations from all four of its workgroups and
announced a new opportunity for public participation in the committee's
activities. The Implementation Workgroup stated that it would like
to learn from the broader public about "real-world" standards
implementation experiences and revealed plans to hold an Oct.29
hearing to take testimony from a broad spectrum of stakeholders.
The committee also will open a two-week online forum following this
hearing, to allow the public to engage in a period of "structured
dialog" about adoption and implementation concerns.
The Clinical Operations Workgroup identified gaps the group believes
the HIT Policy Committee should address, particularly regarding
certain 2011 "meaningful use" criteria. The workgroup
also launched a "Vocabulary" sub-workgroup to propose
solutions on vocabulary and mapping issues and engaged the full
committee in a discussion of requirements relating to patient access
to electronic health records. The Privacy and Security Workgroup
made two technical changes to their earlier recommendations and
identified gaps to be addressed for 2013, including standard vocabulary
for representing consumer consents. The committee also announced
that the majority of its next meeting will be devoted to discussing
security issues.
The meeting agenda and all slides from the workgroup presentations
are available on the HIT Standards Committee Web
site. A more detailed summary of the meeting will be posted
to the AAMC HIT Web page.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
On the Hill...
Rep. Robert Wexler (D-Fla.) Oct. 14 announced
that he is resigning his House seat in January to become president
of the Center for Middle East Peace & Economic Cooperation.
Rep. Wexler is currently serving his seventh term and sits on the
Foreign Affairs and Judiciary Committees.
On the Agenda in Washington
Oct. 19-20: Advisory Panel on Medical Uses of Isotopes Meeting
10:15 a.m.; Executive Boulevard Building (EBB01-B13/15), NRC,
6003 Executive Blvd., Rockville, MD
Advisory Committee on the Medical Uses of Isotopes of the Nuclear
Regulatory Commission (NRC) will hold a partially closed meeting
that will include a report from the International Commission on
Radiological Protection Publication 103; an update on permanent
prostate brachytherapy medical events; an update on results from
the Society of Nuclear Medicine on the medical isotope shortage;
information on the regulatory responsibilities of the Food and Drug
Administration; and a summary of the enforcement process and enforcement
actions against medical licensees.
Oct. 20: HIT Policy Committee Information Exchange Workgroup
Meeting
9 a.m. -3 p.m.; The Omni Shoreham Hotel, 2500 Calvert Street,
NW, Washington, DC
HIT Policy Committee Meeting's Information Exchange Workgroup will
meet
to hear testimony from invited experts and stakeholders in the area
of electronic exchange of laboratory information.
Oct. 21: Senate Judiciary Committee Hearing on Health Care
Fraud
10 a.m.; 226 Senate Dirksen Building
The full Senate Judiciary Committee is scheduled to hold a hearing
titled "Effective Strategies for Preventing Health Care Fraud."
Oct. 26: National Research Advisory Council Meeting
8:30 a.m.; Room GL-20, Greenhoot Cohen Building, 1722 "Eye"
St. NW, Washington, DC
National Research Advisory Council of the Department of Veterans
Affairs (VA) will hold a meeting
to review the VA research portfolio and current budget allocations,
as well as provide feedback on the direction/focus of VA's research
initiatives.
Oct. 27-28: HIT Policy Committee
10 a.m.; The Omni Shoreham Hotel, 2500 Calvert Street, NW, Washington,
DC
The full HIT Policy Committee will meet
to hear presentations from the Meaningful Use, Certification/Adoption,
and Information Exchange Workgroups and will hear testimony from
experts on the mapping of core Meaningful Use objectives and existing
measures to medical specialties, small practices, and small hospitals.
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