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AAMC Submits Comments on Medicaid and CHIP Managed Care Proposed Rule
July 24, 2015 —The AAMC July 23 submitted comments on the Centers for Medicare and Medicaid Services (CMS) proposed rule on the Medicaid and Children’s Health Insurance Program (CHIP) Programs, Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability. In the rule, CMS aimed to improve alignment between Medicaid and CHIP managed care rules and practices with those of other health insurance providers.
The AAMC’s comments focus on network adequacy standards, setting sound capitation rates, graduate medical education (GME), direct payment prohibition, quality of care, and program integrity. The association made specific recommendations for CMS, including the following:
- Require states to establish a process to address inadequate wait times for specialties and subspecialties;
- Be more specific in addressing the health needs of Medicaid populations by ensuring a thoroughly inclusive network of providers;
- Establish a transparent process for patients and stakeholders to raise network adequacy grievances; and
- Clarify that states may set minimum payment rates for providers within a class that meet a certain criterion.
The AAMC also raised concerns with CMS’ proposal to expand the “direct pay prohibition.” The prohibition currently forbids additional payments for services covered under managed care contracts, with some exceptions. CMS would expand the prohibition to stop states from directing plan expenditures under contracts. The final rule will be released later this year.
Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Ways & Means Health Subcommittee Holds Hearing on Hospital Payment Issues
July 24, 2015 —The House Ways and Means Health Subcommittee held a hearing July 22 focused on hospital payment issues, beneficiary access to care, and payment reform options. Medicare Payment Advisory Commission (MedPAC) Executive Director Mark Miller, Ph.D., testified on MedPAC’s June 2015 Report to the Congress and previous MedPAC recommendations on Inpatient Prospective Payment System (IPPS) “add-on” payments, specifically indirect medical education (IME) and disproportionate share hospital (DSH) payments, short-inpatient hospital stays, and site-neutral payment policy.
Health Subcommittee Chair Kevin Brady (R-Texas) opened the hearing by praising his colleagues for their part in reforming the sustainable growth rate formula earlier this year and expressing his desire that the committee “carry this progress over into other payment areas.” He specifically mentioned simplifying and better coordinating Medicare inpatient and outpatient payments, saying, “Now we need to take the next step, and that means looking at Medicare’s acute-care payment systems. I want to raise the topic of ‘site-neutral payment’ reforms. This is a policy MedPAC has highlighted for several years now.”
Chairman Brady questioned Dr. Miller about previous MedPAC work on “site-neutral” payment policy, saying, “I found it striking that MedPAC concluded that Medicare paid roughly $4,240 more on average for an inpatient stay than for a comparable outpatient surgery. This sounds like a good place for Congress to start establishing site-neutral payment. I hope you agree with that.” Miller responded that was an area that MedPAC has begun to examine.
Turning to Dr. Miller’s testimony on Medicare graduate medical education (GME), Rep. Joe Crowley (D-N.Y.) reminded the subcommittee of the shared responsibility between teaching hospitals and the federal government in training the physician workforce, stating “the teaching hospital may be the one receiving the payment to offset a portion of their costs, but it is the whole country who benefits from more well-trained doctors.”
Crowley stressed the importance of GME funding to teaching hospitals’ unique community missions, explaining, “Part of that investment is also in the highly-complex and costly patient care missions that teaching hospitals undertake. They run advanced trauma centers and burn units, they see more complex patient cases, they treat patients with rare and difficult diseases like Ebola. And that helps train future doctors in all those areas…Graduate medical education payments were designed by Congress to reflect all these undertakings, beyond just the explicit costs you may see on paper.”
Dr. Miller explained MedPAC’s June 2010 GME recommendation to redirect a portion of Medicare IME payments by explaining “you take the dollars that exist, you allocate them differently, and you target them to hospitals and other providers who are running GME programs that are more comprehensive in team-based care, evidenced-based medicine, and also alternative sites of care where they’re trained, in addition to the hospital.” He added, “We didn’t talk about eliminating the dollars.”
Crowley closed by saying, “I think you appreciate the teaching of a modern doctor today…I believe we need a stronger investment in graduate medical education, like raising the outdated cap on the number of residents that Medicare supports.” He then urged his colleagues to support his bipartisan legislation, The Resident Physician Shortage Reduction Act of 2015 (H.R. 2124), introduced with Rep. Charles Boustany, M.D. (R-La.), as a starting point to address these concerns.
Several subcommittee members raised concerns with the Hospital Readmission Reduction Program (HRRP), which was established through the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) and aimed at reducing unnecessary hospital readmissions. Rep. Jim Renacci (R-Ohio) specifically focused on the problematic implementation of the program, particularly for hospitals serving a disproportionate share of low-income patients, and the correlation between these hospitals, low-income patients, and readmission penalties. Rep. Renacci then highlighted his bipartisan legislation, The Establishing Beneficiary Equity in the Hospital Readmission Reduction Program (H.R. 1343), which would risk-adjust the HRRP for patients’ socioeconomic status when calculating hospital readmissions as a legislative solution.
Director, Government Relations
Boehner Says Congress Will Act on Continuing Resolution in September
July 24, 2015 —House Speaker John Boehner (R-Ohio) July 23 said that Congress will work on a continuing resolution (CR) when it returns to Washington after the August congressional recess.
Speaking at a press conference, Boehner said, "Well listen, the Democrats in the Senate have blocked any appropriations from coming to the Senate floor.... [I]t's pretty clear, given the number of days we're going to be here in September that we're going to have to do a CR of some sort."
The House has passed six of the 12 annual spending bills, but the Senate has been unable to consider any of the appropriations bills because of Democratic opposition to the spending limits currently in force.
Boehner said "no decision has been made about" the terms of the CR, adding Congress will "deal with it in September when we get back."
Senior Director, Government Relations
NIH Requests Input on Agency-Wide Strategic Plan
July 24, 2015 —The National Institutes of Health (NIH) July 22 released a Request for Information (RFI) inviting comments and suggestions on a framework for a five year NIH-wide strategic plan. The strategic plan was mandated in the 2014 “CRomnibus” federal spending bill and is due to Congress by December 2015 [see Washington Highlights, Dec. 12, 2014].
NIH Principal Deputy Director Larry Tabak, D.D.S., Ph.D., presented an outline of the plan to the NIH Advisory Committee to the Director (ACD) in June. A revised framework based on the committee’s feedback was subsequently presented to ACD members during a July 20 conference call. The framework highlights areas of cross-cutting research opportunities that apply across biomedicine under the categories of: promoting fundamental science, improving health promotion and disease prevention, and advancing treatments and cures. The plan also sets forth unifying principles on NIH priority-setting and stewardship of the research enterprise, which include enhancing workforce diversity and promoting scientific rigor and reproducibility.
The NIH is soliciting input from the research community and general public regarding the proposed framework. The notice states, “the goal of this larger NIH-wide strategic plan is not to outline the myriad of important research opportunities for specific disease applications…but to highlight major trans-NIH initiatives.”
The NIH plans to analyze and incorporate RFI feedback in the fall, prior to finalizing the strategic plan. Comments must be submitted electronically and are due to NIH by Aug. 16.
Anurupa Dev, Ph.D.
Science Policy Analyst
Director, Science Policy
CMS TEP Releases Second Star Ratings Report
July 24, 2015 —A Centers for Medicare and Medicaid Services (CMS) convened technical expert panel (TEP) July 17 released a report for public comment on the proposed methodology used to calculate an overall hospital quality star rating for the Hospital Compare website. Under the TEP’s proposal, hospitals would receive a maximum of five stars for performance on 75 inpatient and outpatient measures.
This is the second report released by the TEP concerning hospital compare star ratings. The AAMC submitted comments on the first report in February 2015 [see Washington Highlights, Feb. 27]. Currently, CMS only publishes star ratings for the Hospital Consumer Assessment of Healthcare Providers (HCAHPS) questions on Hospital Compare.
The report proposes a two-step process for translating the individual measure scores into a star rating. First, the 75 measures are divided into seven separately weighted categories (mortality, safety, readmissions, patient experience, imaging efficiency, process effectiveness and process timeliness) and then combined into a group specific summary score. Next, CMS would use a K-means cluster analysis to turn the hospital group score into a star rating.
This type of analysis is intended to group hospitals in a way that scores in each of the five clusters are closer to their group mean than to any other group mean. Under this methodology, the majority of hospitals would receive three out of five stars.
CMS is currently holding a dry run for hospitals to review their individual overall rating and will hold a National Provider Call explaining the star rating methodology on Aug. 13. Comments on the report are due by Aug. 17.
Scott Wetzel, M.P.P.
Senior Specialist, Health Care Affairs
On the Agenda
July 28-29: HRSA National Advisory Council on Nurse Education and Practice Meeting
9:30 a.m.; Webinar
The Health Resources and Services Administration (HRSA) National Advisory Council on Nurse Education and Practice will meet via webinar to discuss its 13th Report to Congress, advances in Interprofessional education and practice, aligning Interprofessional education with health care transformation, Title VIII programs, and more. A full agenda is available.
July 28: House Hearing to Review HHS Policies and Priorities
10 a.m.; 2175 Rayburn House Office Building, Washington, D.C.
The House Education and the Workforce Committee will hold a hearing to review the policies and priorities of the Department of Health and Human Services (HHS). HHS Secretary Sylvia Mathews Burwell is expected to testify.
July 28: House Subcommittee Hearing on Disparities in Rural Health Care
10 a.m.; 1100 Longworth House Office Building, Washington, D.C.
The House Energy and Commerce Health Committee will hold a hearing to discuss rural health care disparities created by Medicare regulations.
July 28: PCORI Webinar on New Peer Review Requirements for Awards
11:30 a.m.; Webinar
The Patient-Centered Outcomes Research Institute will host a webinar to provide an overview of the new peer review requirements for all past, current, and future funded research awards.
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
Senior Director, Government Relations