Washington Highlights: January 8,
2010
AAMC President
Calls on Congress to Address Doctor Shortage
Contents
Prior Issues
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In a Jan. 4 Wall Street Journal op-ed,
AAMC President and CEO Darrell G. Kirch, M.D., calls on Congress
to "lift the freeze on support for medical training now, as
part of health care reform." Dr. Kirch indicates that this
is an important step to increasing the number of physicians in primary
care and other needed specialties. The article continues, while
the U.S. medical school class-size expands "the overall per
capita supply of doctors in the country will decline without an
expansion in the number of residency training positions." Additionally,
the article states "while the cost to add new physicians is
significant, it is less than 1% of current Medicare expenditures
and an essential investment if people are to have timely access
to a physician's care."
Information:
Atul Grover, M.D., Ph.D., Chief Advocacy Officer
AAMC Government Relations
agrover@aamc.org
(202) 828-0410
AAMC Makes Recommendations for Reconciliation
of Health Care Bills
AAMC President and CEO Darrell G. Kirch, M.D., sent a Dec. 30 letter
to the congressional leadership making key recommendations as they
move forward to reconcile differences between the House-passed "Affordable
Health Care for America Act" (H.R.
3962) and the Senate-passed "Patient Protection and Affordable
Care Act" (H.R.
3590). The letter was sent to Senate Majority Leader Harry Reid
(D-Nev.), Assistant Majority Leader Richard Durbin (D-Ill.), Finance
Committee Chair Max Baucus (D-Mont.), Health, Education, Labor,
and Pensions Committee Chair Tom Harkin (D-Iowa), as well as Sens.
Christopher Dodd (D-Conn.) and Charles Schumer (D-N.Y.). In the
House it was sent to Speaker Nancy Pelosi (D-Calif.), Majority Leader
Steny Hoyer (D-Md.), Energy and Commerce Chair Henry Waxman (D-Calif.),
Ways and Means Chair Charles Rangel (D-N.Y.), Education and Labor
Chair George Miller (D-Calif.), and Assistant to the Speaker Rep.
Chris Van Hollen (D-Md.).
The AAMC recommends that the final health care reform package:
- Expand the physician workforce to avert a decrease in the number
of physicians per capita;
- Reform Medicare's physician payment methodology to preserve
access to physician services;
- Decrease the cuts in Disproportionate Share Hospital (DSH) payments
imposed on teaching hospitals; and
- Forgo the creation of any new independent payment board that
could arbitrarily and disproportionately threaten support for
the missions of teaching hospitals and physicians.
The letters congratulate Congress for "the historic progress
it has made toward reforming the nation's health care system."
The AAMC pledges to continue working with Congress to "ensure
the enactment of policies that strengthen our nation's system of
medical education."
The House and Senate are scheduled to reconvene Jan. 12 and Jan.
18, respctively; however, House and Senate leaders are already working
to reconcile the differences between the two bills.
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
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Members Oppose IMAB
In a Dec. 17 bipartisan letter
to House Speaker Nancy Pelosi (D-Calif.), members of the House urged
the Speaker to "reject the inclusion" of an Independent
Medicare Advisory Board (IMAB) in the final health reform legislation
[see Washington
Highlights,
Aug. 7]. The IMAB was included in the Senate-passed health reform
legislation (H.R.
3590). The letter indicates that it would have broad authority
to craft and execute new Medicare policies with limited Congressional
input.
In the letter, circulated by Rep. Richard Neal (D-Mass.), the members
oppose the creation of a board that "would surrender our legislative
authority and responsibility for the Medicare program to unelected,
unaccountable officials." Additionally, the members state that
beneficiaries and providers would be "greatly limited in their
ability to help develop and implement new polices" by the IMAB.
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
CMS and ONC Issue Rules on EHRs
The Centers for Medicare and Medicaid Services (CMS) Dec. 30 issued
a proposed on the Electronic Health Record Incentive Program. On
the same day, the Office of the National Coordinator for Health
Information Technology (ONC) issued an interim final rule titled
"Initial Set of Standards, Implementation Specifications, and
Certification Criteria for Electronic Health Record Technology."
The CMS proposed
rule has a 60-day comment period that will begin once the rule
is published in the Federal Register, which is expected to
be on Jan. 13. The ONC interim
final rule will be effective 30 days after publication in the
Federal Register, but the comment period extends for 60 days
after publication in the Federal Register. Both rules implement
provisions of the American Recovery and Reinvestment Act (ARRA,
P.L.111-5).
Under ARRA, incentives are not available for "hospital-based
professionals." CMS has chosen to define this term as someone
who provides "substantially all" (i.e., 90 percent or
more) of their services in an inpatient setting or outpatient settings
that are owned by and integrated both operationally and financially
into the hospital. The proposed incentives would not be available
to physicians providing substantially all of their services in provider-based
clinics. CMS defines "hospital" by CCN (formerly known
as the provider number), so that if a system has multiple hospitals
under one CCN, only one hospital would receive the hospital incentive.
The CMS proposed rule defines "meaningful use" for both
the Medicare and Medicaid Electronic Health Record (EHR) incentive
programs. In general, the definition of meaningful use will be similar
under the Medicaid program, although CMS proposes that states can
modify the definition of meaningful use or add objectives. For the
initial period, 2011-2012 ("Stage 1"), the definition
focuses on electronically capturing health information in a coded
format, using that information to track key clinical conditions,
and communicating that information for care coordination purposes;
implementing clinical decision support tools; and reporting clinical
quality measures and public health information. For both hospitals
and physicians this requires achieving an ambitious set of objectives,
including the use of computerized physician order entry (CPOE),
maintaining an active medication list, and implementing 5 clinical
decision support rules. To qualify for payment, all objectives must
be met.
Eligible professionals and eligible hospitals also must submit
summary information to CMS on clinical quality measures for the
following specialty groups: cardiology, pulmonology, endocrinology,
oncology, proceduralist/surgery, primary care, pediatrics, obstetrics
and gynecology, neurology, psychiatry, ophthalmology, podiatry,
radiology, gastroenterology, and nephrology.
Finally, "meaningful use" is achieved by using certified
EHR technology. The ONC interim final rule establishes capabilities
and related standards that certified EHR technology will need to
include to, at a minimum, achieve meaningful use in Stage 1. The
interim final rule begins to define a common language to ensure
accurate and secure health information exchange across different
EHR systems.
The AAMC will provide members with additional information in writing
and through teleconferences, and will comment on the rules.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Morgan Passiment, Director
AAMC Information Resources Outreach
mpassiment@aamc.org
(202) 828-0476
OMB Issues New Guidance on Recovery Act Reporting
The Office of Management and Budget (OMB) Dec. 18 issued "updated
guidance" to federal agencies and award recipients concerning
reporting requirements under the American Recovery and Reinvestment
Act (ARRA, P.L.
111-5). OMB provided agencies with a standard methodology for
reviewing the quality of data submitted by recipients as well as
standard reporting formats to provide data to OMB.
For the extramural research community, OMB provided awardees with
"important simplifications to the manner in which job estimates
are calculated and reported." Recipients will now report job
estimates on a quarterly basis. Earlier guidance had required cumulative
job estimates. In addition, OMB is no longer requiring awardees
to make subjective judgments on whether jobs were created or retained
as a result of the Recovery Act. OMB states, "Instead, recipients
will more easily and objectively report on jobs funded with Recovery
Act dollars." OMB says that these changes are based on recommendations
from the Government Accountability Office (GAO).
OMB's new guidance (on page 14) explicitly acknowledges the variable
effort calculation methodologies allowed under OMB Circular A-21,
Cost Principals for Educational Institutions. OMB will allow educational
institutions to use the same methodology they use under A-21 to
calculate full workload.
OMB is not requiring recipients to revise earlier reports. However,
OMB states, "Recipients should implement the updated methodology
to the greatest extent possible for the January reporting period."
Based on the OMB notice, some agencies (such as the National Science
Foundation) have issued related agency-specific guidance.
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
GAO Appoints Members to New Medicaid and CHIP
Commission (MACPAC)
The U.S. Government Accountability Office (GAO) Dec. 23 announced
the appointment of 17 members to the new Medicaid and Children's
Health Insurance Program (CHIP) Payment and Access Commission (MACPAC),
an independent federal body that will advise Congress on issues
affecting the CHIP and Medicaid programs.
The commission was established by the Children's Public Health
Insurance Reauthorization Act of 2009 (P.L. 111-3) and comprises
a mix of different professionals who bring expertise in the financing
and delivery of health care services. The members are charged with
reviewing Medicaid and CHIP access and payment policies.
The commission chair is Diane Rowland, Sc.D., Executive Vice President
of the Henry J. Kaiser Family Foundation and Executive Director
of the Kaiser Commission on Medicaid and the Uninsured. The vice
chair is David Sundwall, M.D., who has been the Executive Director
of the Utah Department of Health and Commissioner of Health for
the State of Utah since 2005. Two hospital CEOs are among the commissioners.
Patricia Gabow, M.D., is the Chief Executive Officer of Denver Health
and Hospital Authority. Herman Gray, M.D., MBA, is the President
of Children's Hospital of Michigan (CHM) and Senior Vice President
of the Detroit Medical Center and has previously served as associate
dean for graduate medical education (GME) and Vice president for
the GME at Wayne State University School of Medicine and the Detroit
Medical Center, respectively.
The full list of commissioners, including their biographies, is
included in the GAO's Dec. 23 press
release.
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
On the Hill...
Sen. Christopher Dodd (D-Conn.) Jan. 6 announced
that he would not seek re-election at the completion of his sixth
term in 2010 to spend more time with his family. Sen. Dodd is the
second ranking Democrat on the Senate Health, Education, Labor and
Pensions Committee and sheparded health care reform through the
committee in Chairman Ted Kennedy's absence.
Sen. Byron Dorgan (D-N.D.) Jan. 5 announced in a press statement
that he would not seek re-election to a fourth term in November.
Sen. Dorgan is the eighth ranking Democrat on the Senate Appropriations
Committee.
Rep. Parker Griffith, M.D., (Ala.) Dec. 22 announced his intent
to leave the House Democratic Caucus and join the House Republican
Conference. With Rep. Griffith's switch, the Democratic majority
of the House of Representatives is 257-178.
On the Agenda in Washington
Jan. 12: House Convenes for Second Session
The House is scheduled to convene the second session of
the 111th Congress Jan. 12. Planned recesses include a week-long
Presidents Day recess beginning Feb. 13, a two-week spring recess
after wrapping up business March 26, and week-long breaks for Memorial
Day and for Independence Day. Summer recess is scheduled to begin
Aug. 6, with the House planning to reconvene Sept. 14. House leaders
are aiming to adjourn by Oct. 8 during this election year.
Jan. 13: HIT Policy Committee Meeting
9 a.m., The Park Hyatt Hotel, 24th and M Sts.
NW
The HIT Policy Committee of the Office of the National Coordinator
for Health Information Technology will meet
to hear reports from its workgroups, including the Meaningful Use
Workgroup, the NHIN Workgroup, the Privacy and Security Policy Workgroup,
and the Strategic Plan Workgroup.
Jan. 19: Senate Convenes for Second Session
The Senate is scheduled to begin the second session of the
111th Congress Jan. 19. Planned recesses include a week-long Presidents
Day recess beginning Feb. 13, a two-week spring recess after wrapping
up business March 26, and week-long breaks for Memorial Day and
for Independence Day. Summer recess is scheduled to begin Aug. 6,
with the Senate planning to reconvene Sept. 13. Senate leaders have
not set a target adjournment date for 2010.
Jan. 20: AHRQ Comparative Effectiveness Research Clinical
Registries Advisory Committee Meeting
8 a.m.; Marriott RIO, 9751 Washingtonian Blvd., Gaithersburg,
Md.
The Agency for Healthcare Research and Quality (AHRQ) will
hold a meeting
of a Health Care Policy and Research Special Emphasis Panel titled
"AHRQ Developing Prospective Practice-based Comparative Effectiveness
Research Clinical Registries: Orthopedic Devices, Drugs and Procedures."
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