Washington Highlights: May 9, 2008
Contents
Prior Issues
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Judge Says CMS Likely Violated Medicaid Moratorium
Federal District Court Judge James Robertson May 7 stated he was
inclined to rule that the Centers for Medicare and Medicaid Services
(CMS) had violated the 2007 "Medicaid moratorium" preventing
promulgation of the Medicaid final rule on cost limits and units
of government (the "IGT Rule"). Judge Robertson made his
remarks during a summary judgment hearing on the lawsuit filed March
11 by the AAMC and others challenging CMS's authority to finalize
the IGT Rule on the same day the President enacted the moratorium
[see Washington
Highlights,
March 14].
The judge also indicated he was inclined to rule that the regulation
does not violate federal law. He noted that the rule involves "complicated
questions" that are better addressed by CMS and Congress. Judge
Robertson's findings are not official until he issues a written
opinion, which is expected by May 23. He advised that his final
opinions may differ from his May 7 remarks.
In addition to challenging the timing of the final rule, the March
11 lawsuit filed by the AAMC, National Association of Public Hospitals,
the American Hospital Association, and Alameda County Medical Center,
asked the court to strike down the IGT rule because of its potentially
devastating impact on public hospitals, many of which are safety
net providers.
The lawsuit argues that Medicaid statute bars CMS from imposing
provider-specific cost limits on public hospitals. The suit also
argues that CMS overstepped its authority by narrowing the definition
of "unit of government," thereby excluding many public
hospitals from contributing to the Medicaid "state share"
which is matched by the federal government.
If the judge concludes that CMS violated the current Medicaid moratorium,
the agency must reissue the final rule and allow 60 days for Congressional
review. However, CMS cannot reissue the rule until after the current
moratorium expires on May 25, or later if Congress passes and the
President signs an additional moratorium.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.orc
(202) 828-0490
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
AAMC Testifies before IOM Committee on Resident
Duty Hours
Debra Weinstein, M.D., Vice President for Graduate Medical Education,
Partners Health Care Systems, testified
May 8 on behalf the AAMC at an Institute of Medicine (IOM)
committee hearing
concerning optimizing resident duty hours. This hearing is one in
a series in an effort to evaluate the current evidence on resident
schedules and patient safety and develop strategies to improve overall
safety and quality health care. Dr. Weinstein noted that "health
care is delivered in a highly complex system where any significant
change will have ripple effects and potentially unforeseen consequences;
we are only now in a position to perform new studies to better understand
these implications."
Dr. Weinstein was joined by representatives from The Joint Commission
and the American Board of Medical Specialties. All witnesses concluded
that there is no current evidence base by which to determine the
impact duty hour restrictions have had on resident education, trainees'
"preparedness," and delivery of patient care. The presenters
also discussed the need for stakeholders to come together and reach
a consensus on a research agenda with adequate funding. Representatives
of all three organizations suggested that there is a need to assess
adequately the 2003 reduction in resident duty hours and consider
potential unintended consequences before making changes to specific
duty hour limits currently in effect.
Information:
Sunny Yoder, Director of Resident Affairs
AAMC Health Care Affairs
syoder@aamc.org
(202) 828-0497
Travis W. Crytzer, Legislative Associate
AAMC Health Care Affairs/Government Relations
tcrytzer@aamc.org
(202) 828-0418
House, Senate Delay Action on War Funding Bill
Both the House and Senate postponed planned actions on a supplemental
spending bill to fund the war in Iraq and Afghanistan.
Facing opposition within their own party from the conservative
Blue Dog Coalition, House Democratic leaders delayed plans to bring
the supplemental bill directly to the House floor, bypassing the
House Appropriations Committee. The Blue Dogs object to a provision
in the supplemental that increases education benefits for veterans
without an offset, as required by the "pay-as-you-go"
rules the Democrats adopted when they regained control of Congress
in 2007.
House Republicans, upset that Democratic leaders opted to bypass
the Appropriations Committee, also have employed tactics to delay
floor consideration of the supplemental.
Meanwhile, Senate Appropriations Chair Robert Byrd (D-W.Va.) "very
reluctantly agreed to the request of the House and Senate Democratic
leadership" to postpone a May 8 committee mark-up of the bill.
The mark-up is now scheduled for May 15.
A May 7 press release
from the Appropriations Committee states the supplemental will include
a provision to further delay "seven Medicaid rules issued by
the Bush Administration," including the GME and IGT rules.
According to a May 7 press
release issued by Senator Tom Harkin (D-Iowa), chair of the
Senate Labor-HHS-Education Appropriations Subcommittee, the Senate
supplemental will include an additional $400 million for NIH in
FY 2008.
Information:
Dave Moore, Senior Associate Vice President
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Oversight Committee Considers Impact of Medicaid
Regulations on Emergency Surge Capacity
The House Committee on Oversight and Government Reform held a two-day
(May 5 and 7) hearing
to explore the potential impact that recently issued Medicaid regulations
might have on hospital emergency surge capacity. The hearing focused
specifically on whether the Medicaid IGT final rule, Medicaid GME
proposed rule, and Medicaid outpatient proposed rule would impede
the ability of Level I trauma centers to respond to "the most
likely terrorist attack ... one using bombs or other conventional
explosives."
In preparation for the hearing, committee majority staff conducted
a March 25, seven-city survey of 34 Level I trauma centers in Washington,
New York, Los Angeles, Chicago, Houston, Denver, and Minneapolis.
According to the survey, "none of the hospitals surveyed ...
had sufficient emergency care capacity to respond to an attack."
The responses also indicated "that the level of emergency care
... is likely to be further compromised by [the] three new Medicaid
regulations." Several committee Republicans, including Rep.
Darrell Issa (R-Calif.) questioned the validity and value of the
survey, calling it "partisan," "amateur," and
"self-serving."
On May 5, J. Wayne Meredith, M.D., Chairman of Surgery at Wake
Forest University Baptist Medical Center, expressed concern that
the Medicaid GME proposed rule would threaten the financial viability
of training programs in trauma surgery, burn care, and related physician
specialties. Dean of the Vanderbilt School of Nursing Colleen Conway
Welsh, Ph.D., expressed similar concern. Roger Lewis, M.D., Ph.D.,
Professor of Emergency Medicine at Harbor-UCLA Medical Center criticized
the GME and IGT regulations for "specifically targeting the
teaching hospitals," that maintain costly and necessary Level
I trauma services.
Secretary of Health and Human Services Michael Leavitt and Secretary
of Homeland Security Michael Chertoff testified May 7. In defense
of the regulations, Secretary Leavitt explained the regulations
attempted to ensure that states continue contributing their "fair
share" of funding to the Medicaid program. He added that the
"continuation of abusive [financing] practices" by states
... is not the appropriate way to ensure our nation's preparedness."
On several occasions Secretary Leavitt advised the committee that
Medicaid "cares for people," is not a "hospital entitlement,"
and should not compensate for inadequate emergency preparedness
funding at the state level.
Committee Chair Henry Waxman (D-Calif.) asked why the Department
of Health and Human Services published the regulations without "consulting"
the Department of Homeland Security (DHS). He also asked why DHS
chose to "stand by" while the Medicaid regulations "compromised"
local emergency surge capacity. Secretary Chertoff responded that
"it is not the responsibility" of DHS to "direct"
how other agencies "perform their specific roles and responsibilities
when managing a major incident."
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
House Panel Debates Stem Cell Research
The House Energy and Commerce Subcommittee on Health May 8 held
a hearing
to discuss embryonic and other forms of stem cell research. Director
of the National Institutes of Health (NIH) Elias Zerhouni, M.D.,
testified that stem cell research is currently the most important
area in medical research because of the sheer number of people that
could be cured through the potential therapies. In addition, he
agreed with many Democratic members of the subcommittee that all
areas of stem cell research, including embryonic, should be explored
because no one can predict what will lead to the next breakthrough.
The panel also inquired about the current lines of embryonic cells
available for research. Dr. Zerhouni noted that while some researchers
are able to use those, many are finding that the samples are too
old, contaminated, or are not exactly what they need to further
their research. Committee members on both sides of the aisle acknowledged
that there are great advances using adult stem cells, umbilical
cord and placental stem cells, and induced pluripotent cells (iPS),
or regenerated cells. However, there was disagreement on whether
permitting research on embryonic stem cells is preferable to current
methods alone.
Information:
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
Former HHS Secretaries Discuss Health Care Reform
before Senate Panel
Former Secretaries of Health and Human Services (HHS) Donna Shalala,
Ph.D., and Tommy Thompson, J.D., May 6 testified before the Senate
Finance Committee in the first hearing of a series designed to engage
Congress in a national health care reform debate. Committee Chair
Max
Baucus (D-Mont.) and Ranking Member Charles
Grassley (R-Iowa) agreed they are committed to working in a
bipartisan manner to reform the health care system. Although the
committee agreed no major action on health care reform would take
place in the current session, the series of hearings will prepare
the next Congress for the debate.
Shalala, currently president of the University of Miami, and Thompson,
currently president of Logistics Health, Inc., agreed the problem
with the U.S. health care system lies neither with the caregivers
nor with the quality and technology of the care itself, but with
rising costs.
According
to Shalala, although covering the uninsured requires initial
investments, the United States ultimately will benefit from a universal
strategy that utilizes a cost containment approach. Shalala noted
that "only with the successful implementation of a universal
health care strategy, will the United States have the potential
to not only extend quality coverage to the millions of Americans
currently uninsured, but also have the opportunity to save billions
of dollars in the process." Shalala also encouraged implementation
of electronic medical records, describing their "potential
to dramatically cut health care costs by improving communication
between physicians, enhancing the capacity of health care providers
to efficiently perform surveillance and monitoring of care delivery,
and decreasing the utilization of care by patients who chronically
abuse the system."
Thompson
also acknowledged the vast savings in health care costs promised
through a new and improved health information system, and expressed
strong support for advances in Health Information Technology (HIT).
With respect to health care coverage, Thompson favored "creating
opportunities for access and creating a marketplace for competition"
through "refundable tax credits for individuals and families,"
as proposed by presumed Republican presidential nominee Sen. John
McCain (Ariz.). Thompson also emphasized the importance of prevention
and healthier lifestyles at the workplace and at home.
Information:
Travis W. Crytzer, Legislative Associate
AAMC Health Care Affairs/Government Relations
tcrytzer@aamc.org
(202) 828-0418
On the Hill
Rep. Steve Scalise (R-La.) was sworn in to the House of Representatives
May 7, after winning a May 3 special election. Rep. Scalise will
finish the term of Gov. Bobby Jindal (R), who resigned in January.
House Democrats added another seat to their majority May 6, as
Rep. Don Cazayoux (D-La.) was sworn in to office. Rep. Cazayoux
succeeds former Rep. Richard Baker (R), who resigned to head a hedge
fund trade group.
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