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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.

House Ways and Means Committee Passes Hospital Payment Reforms

May 27, 2016—The House Ways and Means Committee May 24 passed by voice vote, “The Helping Hospitals Improve Patient Care Act of 2016” (H.R. 5273), legislation that would incorporate consideration of socioeconomic status (SES) in the Medicare Hospital Readmissions Reduction Program (HRRP), and provide a narrow Sec. 603 exemption for “mid-build” off-campus hospital outpatient departments (HOPDs) at the time of enactment of the Bipartisan Budget Act of 2015, among other provisions [see Washington Highlights, May 20].

AAMC President and CEO Darrell Kirch, M.D., issued a statement applauding the committee “for passing this important legislation that will help the nation’s medical schools and teaching hospitals provide care to all who need it.”

Dr. Kirch further highlighted the AAMC’s longstanding leadership in promoting the importance of risk-adjusting for the socioeconomic status of patients in measures used to determine penalties under the HRRP stating, “Medical schools and teaching hospitals treat a larger proportion of our nation’s most medically complex and vulnerable patients, and the provisions in the hospital package passed by the committee will make sure that they are not unfairly penalized for factors outside their control.”

Health Subcommittee Chair Pat Tiberi (R-Ohio) opened the markup stating, “As Members of Congress we talk a lot about removing paperwork burdens and allowing providers to concentrate on what matters most – delivering patient care.” He continued, “This bill will help hospitals attain the revenue they anticipated when they made the decision to invest in new construction projects. It’s just common sense to recognize the reality of business practices. No one likes to think of health care as a business, but hospitals have to keep the lights on to treat patients, just like any other business.”

Ways and Means Committee Chair Kevin Brady (R-Texas) praised the committee’s commitment to taking “quick action” on legislation that “will promote greater access, increase choices, and improve the quality of health care.”

Ranking Member Sander Levin (D-Mich.) echoed similar sentiments and said the HOPD fix specifically “brings fairness to those hospitals.”

Rep. Joe Crowley (D-N.Y.) commended the committee’s bipartisan work to improve patient care stating, “Hospitals all across the country were facing tremendous uncertainty after the Bipartisan Budget Act. I’m glad this bill recognizes the important role that hospitals play, not just as centers of care, but as economic drivers and catalysts for community health. This bill strengthens the HRRP program, to not only focus on reducing preventable readmissions but to ensure that hospitals that treat particularly complex and vulnerable patients are not unfairly penalized.”

Finally, Rep. Ron Kind (D-Wis.) asked that, moving forward, the chairman continue to consider hospital payment issues including the “Advancing Medical Resident Training in Community Hospitals Act of 2016” (H.R. 4732). The legislation would allow hospitals that have inadvertently, and often unknowingly, established medical resident training programs with artificially low resident caps and/or per-resident-amounts (PRA), to build residency training programs and receive the appropriate Medicare-support [ see Washington Highlights, March 18].


Len Marquez
Director, Government Relations
Telephone: 202-862-6281

Courtney Summers
Senior Legislative Analyst
Telephone: 202-862-6042


51 Senators, 235 Representatives Sign Dear Colleague Letters to CMS on HOPD Issue

May 27, 2016—Senators Rob Portman (R-Ohio) and Charles Schumer (D-N.Y.) May 19 and Representatives Devin Nunes (R-Calif.) and Joe Crowley (D-N.Y.) May 24 sent similar letters to Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt asking the agency to incorporate flexibility for several considerations as the administration develops upcoming rulemaking for Sec. 603 of the Bipartisan Budget Act of 2015 (BBA, P.L. 114-74) [see Washington Highlights, Oct. 30, 2015].

The letters were signed by a total of 51 Senators and 235 Representatives. 

Effective Jan., 1, 2017, Section 603 of the BBA equalizes reimbursement rates between services provided at newly established off-campus hospital outpatient departments (HOPDs) and physician offices or ambulatory surgical centers (ASC). After the date of the legislation’s enactment, any site that entered into a Medicare provider agreement but is not on the main campus of a hospital and is located more than 250 yards away from the main campus, must seek reimbursement through the ASC prospective payment system or the Medicare Physician Fee Schedule (PFS).

The House letter references the provision’s impact on patient care stating, “The facilities impacted by this law often serve the most vulnerable patient populations in difficult-to-serve areas, and a number of clarifications in the rule are needed to ensure they can continue serving their communities. While many hospitals have projects underway or planned for the near future, others must take a longer view in their strategic planning to meet the needs of a changing population including opportunities to develop and expand needed services as patient-care needs shift.”

The Senators similarly urged CMS to demonstrate “flexibilities to enable hospitals to continue to serve patients in these settings as well as provide predictability for the hospital field,” including “additional services provided at a dedicated emergency department (DED), relocation or rebuilding for already existing HOPDs, change of ownership, and needed expansion of services and personnel to meet patient care needs of a community.”

The letters were sent just prior to a May 24 Ways and Means Committee markup of “The Helping Hospitals Improve Patient Care Act of 2016” (H.R. 5273), legislation that incorporated a narrow Sec. 603 exemption for “mid-build” off-campus HOPDs (see related story).


Len Marquez
Director, Government Relations
Telephone: 202-862-6281


NIH Issues Notice on Research Involving Chimpanzees

May 27, 2016—The National Institutes of Health (NIH) May 26 released a notice limiting the permissible types of research involving chimpanzees. As of May 25, NIH will not fund any new or competing grants involving chimpanzees, with the exception of “noninvasive research,” which includes visual observation and behavioral studies.

Research applications proposing the use of chimpanzees will additionally be subject to an updated agency review process. NIH Director Francis Collins, M.D., Ph.D., announced last year that NIH would no longer maintain a colony of chimpanzees or support biomedical research on those animals. He noted the decisions were “specific to chimpanzees” and that “research with other non-human primates will continue to be valued, supported, and conducted by the NIH.”

The NIH Office of Science Policy will be holding a workshop on Sept. 7 to ensure the continued responsible oversight of research with non-human primates, and is soliciting comments on possible discussion topics in advance of the meeting.


Anurupa Dev, Ph.D.
Senior Science Policy Analyst
Telephone: 202-862-6048


On the Agenda

The House and Senate are both in recess and will return on June 6.

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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.

For More Information

Dave Moore
Senior Director, Government Relations
Telephone: 202-828-0559