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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

AAMC Commends Senate Finance Committee on Chronic Care Bill

May 19, 2017—The Senate Finance Committee May 18 approved, 26-0, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S. 870). The bill will now move to the full Senate floor for consideration. The committee adopted an amendment introduced by Senators Tom Carper (D-Del.) and Pat Roberts (R-Kan.) that will provide Medicare Part D prescription drug plans with Parts A and B claims data to promote the appropriate use of medications and improve health outcomes.

The legislation includes important provisions that will streamline Medicare’s payment system to incentivize the appropriate level of care, increase care coordination among individual providers across care settings who are treating individuals living with chronic illnesses, and facilitate the delivery of high quality care.

In a letter to the Senate Finance Committee, the AAMC praised the committee’s recognition of the importance of advancing team-based care, expanding innovation and technology, and identifying the chronically ill population to ensure better care.

Earlier in the week, Senators Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.) May 16 held a hearing titled Examining Bipartisan Medicare Policies that Improve Care for Patients with Chronic Conditions. The hearing focused largely on the bipartisan CHRONIC Care Act. The legislation, introduced by the co-chairs of the Chronic Care Working Group, Senators Johnny Isakson (R-Ga.) and Mark Warner (D-Va.), focuses on improving Medicare policies for seniors suffering from one or more chronic conditions.

Testifying witnesses included Senators Brian Schatz (D-Hawaii) and Roger Wicker (R-Miss.) in panel one, and Katherine Hayes, JD, director of health policy, Bipartisan Policy Center; Lee H. Schwamm, MD, on behalf of the American Heart Association/American Stroke Association; John G. Lovelace, president of Government Programs and Individual Advantage, UPMC Insurance Services Division; and Stephen Rosenthal, senior vice president, Montefiore Health System.

Chairman Hatch opened the hearing by praising the deliberate, bipartisan approach taken by the committee, stating “After two years of meeting with and receiving input from stakeholders in the healthcare community, including 850 formally submitted comments, the release of multiple public proposals and outlines, and good-faith negotiations, we have arrived to where we are today. The CHRONIC Care Act currently has 18 bipartisan cosponsors, with 16 sitting on this committee. The bill includes a number of policies that will improve care for the chronically ill through increased use of telehealth, including by giving Medicare Advantage plans and certain Accountable Care Organizations enhanced flexibility to target telehealth services to Medicare patients with chronic conditions. The bill also goes beyond telehealth by making improvements for beneficiaries who receive care across the Medicare spectrum, including fee-for-service, Accountable Care Organizations, and Medicare Advantage. These are all important changes that will address the growing need to tailor treatments to those with chronic conditions.”

Senator Wyden also lauded the provisions of the bill that will help those seniors living with chronic conditions. He stated, “The CHRONIC Care Act will mean more care at home and less in institutions. It’ll expand the use of life-saving technology. It places a stronger focus on primary care. It gives seniors, however they get Medicare, more tools and options to receive care specifically targeted to address their chronic illnesses and keep them healthy. Those are all important steps forward in updating the Medicare guarantee. Still to come is ensuring that every senior with multiple chronic conditions has an advocate to help them navigate through the Byzantine health care system.”


Catie Spivey, JD
Sr. Legislative Analyst, Gov't Relations
Telephone: 202-862-6042


House Appropriations Hearing Highlights Strong Bipartisan Support for NIH

May 19, 2017—A week before the expected release of the president’s full budget request, the House Labor, Health and Human Services, and Education Appropriations Subcommittee May 17 convened an oversight hearing to discuss the impact of the National Institutes of Health (NIH). 

Subcommittee Chair Tom Cole (R-Okla.) opened the hearing by celebrating the success of the NIH. “Investment in NIH has been the key driver in making the United States the world leader in biomedical research and has led to vast improvements in life expectancy and quality of life,” he said, noting that NIH funds medical research throughout the country.

Chairman Cole also highlighted the $2 billion increase Congress provided the NIH in fiscal year (FY) 2017 [see Washington Highlights, May 5] and expressed his dismay with the proposed FY 2018 NIH cuts put forward by the Trump Administration in its preliminary budget [see Washington Highlights, March 17]. Specifically, the president’s budget blueprint proposes to provide $25.9 billion for NIH in FY 2018, which would be an $8.2 billion cut below the comparable FY 2017 level and the lowest level for the agency since FY 2002. If implemented, Chairman Cole said the cuts “would stall the progress that our recent investments were intended to achieve and potentially discourage promising scientists from entering or remaining in biomedical research.” Subcommittee Ranking Member Rosa DeLauro (D-Conn.) urged her colleagues to reject the proposed NIH cuts, saying they “cannot turn back the clock” on the progress of the subcommittee and work at the NIH.

NIH Director Francis Collins, MD, PhD, testified on behalf of the agency and was joined by five NIH institute directors. In his opening testimony, Dr. Collins explained, “Virtually none of the substantial gains in reducing human suffering and extending longevity over the last century would have happened without basic science.” He also thanked the subcommittee for the FY 2017 budget increase, saying it will “ensure that our nation remains the global leader in the life sciences and advances in human health.”

In addition to questions about the public health impact of investments in medical research, members of the subcommittee inquired about the economic impact of NIH. Dr. Collins explained that, thanks to research, the cancer death rate has been dropping one percent per year and, “Each one percent drop is worth $500 billion to our economy.”  When Rep. Katherine Clark (D-Mass.) posed a question about job creation, Dr. Collins replied that the NIH supports 379,000 jobs directly, but the broader research ecosystem that depends on NIH as its foundation supports 7 million jobs nationwide.

In response to questions from Rep. Andy Harris (R-Md.) regarding the federal government’s support for facilities and administrative expenses (F&A) for research, also referred to as “indirect costs,” Dr. Collins described the substantial impact that cuts to F&A reimbursement would have on universities and other research institutions and, by extension, on the research enterprise. Rep. Mark Pocan (D-Wis.) also expressed concern that cuts to F&A reimbursement would negatively affect research institutions, noting that comparisons to foundations are misleading, and Rep. Mike Simpson (R-Idaho) reminded the panel that the magnitude of the administration’s proposed cut would necessarily lead to less research.

Subcommittee members also raised the budget blueprint’s proposed elimination of the Fogarty International Center. Ranking Member DeLauro expressed her concerns that the proposal would threaten the nation’s ability to respond to emerging infectious diseases. In response, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, pointed out that many of the scientific leaders who were in charge of responses to global health crisis, like AIDS or Zika, were scientists trained at the Fogarty International Center. He said these scientists are part of an army “in defense of disease” who will continue to have an impact.


Tannaz Rasouli
Sr. Director, Public Policy & Strategic Outreach
Telephone: 202-828-0525

Joseph Bañez
Legislative Analyst
Telephone: 202-739-2995


FOVA, AAMC Congressional Briefing Showcases VA Research Advancements

May 19, 2017—The AAMC, as an executive committee member of the Friends of VA Medical Care and Health Research (FOVA), hosted a May 16 congressional briefing in partnership with the Department of Veterans Affairs (VA) Office of Research and Development, titled Veterans Health Research: A Showcase and Advancements. 

The event introduced the new VA chief research and development officer, Rachel Ramoni, DMD, ScD. Patricia A. Dorn, PhD, director of VA rehabilitation research and development service, also provided opening remarks. The briefing featured live demonstrations of VA rehabilitation research including:

  • brain-computer interface;

  • peripheral nerve interfaces for natural sensation and control in amputees;

  • the standing wheelchair; and

  • exoskeleton-assisted walking in persons with SCI.

The researchers all highlighted academic partners who had contributed to their success. 

For FY 2018, the FOVA recommends $713 million for VA Medical and Prosthetic Research, a $38 million (5.6 percent) increase over the comparable FY 2017 level, and urges $65 million for the Million Veterans Program not to undercut other critical research priorities. In support of VA research infrastructure, FOVA recommends $50 million for major construction projects and $175 million for nonrecurring maintenance and minor construction.


Matthew Shick, JD
Director, Gov't Relations & Regulatory Affairs
Telephone: 202-862-6116


340B Implementation Date Delayed

March 19, 2017—The Department of Health and Human Services (HHS) May 18 released an update to the final rule that revises the implementation date for the calculation of the 340B ceiling price and application of civil monetary penalties (CMPs) that will apply to all drug manufacturers that are required to make their drugs available to covered entities under the 340B Drug Pricing Program. The policy changes were initially postponed to May 22 in accordance with the Jan. 20 memorandum from the administration. The policies will now begin on Oct. 1, 2017. 

The rule finalized the:

  • requirement that a manufacturer calculate the 340B ceiling price on a quarterly basis;

  • new “penny pricing” policy for certain drugs that requires manufacturers to charge $0.01 per unit measure for a drug whose calculated ceiling price is less than $0.01;

  • new methodology manufacturers must use when estimating the ceiling price for a covered outpatient drug; and

  • explanation of how a CMP would be imposed on a manufacturer that knowingly and intentionally overcharges a covered entity.


Mary Mullaney
Director, Hospital Payment Policies
Telephone: 202-909-2084


On the Hill

May 19, 2017—Congressman Jason Chaffetz (R-Utah) May 18 announced he will be resigning from Congress effective June 30, 2017.

The Energy and Commerce Committee Subcommittee on Health May 18 advanced the FDA Reauthorization Act of 2017 (H.R. 2430) legislation that will reauthorize the FDA’s user fee programs.

The Ways and Means Committee Subcommittee on Health held a May 18 hearing on the Current Status of the Medicare Program, Payment Systems, and Extenders.

On the Agenda

May 22: Department of Veterans Affairs Meeting on VA Genomic Health Care
9 a.m.; 815 14th St. NW, Washington D.C.
The Department of Veterans Affairs Genomic Medicine Program Advisory Committee will hold a meeting to receive program updates and continue to provide insight into optimal ways for VA to incorporate genomic information into its health care program while applying appropriate ethical oversight and protecting the privacy of Veterans.

May 23: House Energy and Commerce Committee Hearing on the Zika Public Health Response
10 a.m.; 2123 Rayburn House Office Building, Washington, D.C.
The House Energy and Commerce Committee will hold a hearing to examine the U.S. public health response to the Zika virus and any continuing challenges.

May 24: House Budget Committee Hearing on the FY2018 Budget
9:30 a.m.; 1334 Longworth House Office Building, Washington, D.C.
Director Mick Mulvaney is expected to testify at a hearing on the FY2018 budget.

May 24: House Appropriations Committee Hearing on Indian Health Service Budget
1 p.m.; 2007 Rayburn House Office Building, Washington, D.C.
The House Appropriations Committee will hold a hearing on the Indian Health Service Budget.

May 24-25: Department of Veterans Affairs Meeting on Veterans Health Programs
8:30 a.m.; 810 Vermont Avenue NW, Room 530, Washington D.C.
The Department of Veterans Affairs Advisory Committee on Prosthetics and Special Disabilities Programs will have a meeting with briefings on Spinal Cord Injury and Disorders; VA Eye Care; Workforce Management; Women’s Health Services; and Caregiver Program and Community Care.

May 25: Department of Health and Human Services Meeting on Healthcare Research
8 a.m.; 9751 Washingtonian Blvd, Gaithersburg, Maryland
The Agency for Healthcare Research and Quality will hold a meeting of the Health Care Research and Training Subcommittee of the Health Services Research Initial Review Group Committee.

May 25: National Institutes of Health Meeting on Mental Health Programs
9 a.m.; NIH Neuroscience Center, 6001 Executive Blvd, Rockville Maryland
The National Institutes of Health will hold a meeting of the National Advisory Mental Health Council.

May 25: National Institutes of Health Meeting on HHS Biomedical Research
8:15 a.m.; 9000 Rockville Pike, Building 31, C Wing, Sixth Floor, Conference Room 10, Bethesda, Maryland.
The National Institutes of Health will hold a meeting of the Council of Councils with briefings to include History of the Knockout Mouse Program (KOMP); KOMP2 translational scientific resource to catalyze biomedical research and accelerate precision medicine; Background on NIH and Federal Budget Process; Progress and Plans at the NIA; and Discussion and Study of possible bias concerning race, gender, seniority and institution and within the peer review process; Common Fund Diversity Program-Introduction and Update and Discussion; Coming into Focus-The NIH and Health Research in Tribal Nations; and Closing Remarks.

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806