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Second Opinion Podcasts

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

AAMC Comments on EHR Certification Criteria under Joining Forces Banner

April 18, 2014—As part of AAMC’s commitment to Joining Forces, AAMC President and CEO Darrell G. Kirch, M.D., sent an April 18 letter  to the Office of the National Coordinator for Health Information Technology (ONC) urging the inclusion of military service criteria in certified electronic health records (EHRs). The letter responds to a request for comment on 2017 EHR Certification Criteria in a Feb. 26 notice of proposed rulemaking. Comments are due to ONC no later than 5 p.m. on April 28.

AAMC’s comments focus on the “unasked question” of military service connections.  Dr. Kirch states, “The stress of war, multiple deployments, and frequent moves create unique wellness challenges for military families. Military personnel returning from Iraq and Afghanistan may carry with them visible and much more subtle wounds.  While military families exhibit great resilience, children, spouses, and parents can experience anxiety; changes in relationships with family and friends; isolation; or emotional challenges in dealing with relocation, deployments, illness, or injury of their loved ones.  Asking about a person’s connections to the military is important for all patients.”

The letter notes AAMC’s endorsement of the question, “Have you or a loved one served in the military?” To that end, the AAMC letter supports the addition of “Family Connection to Military Service” to the proposed military status EHR criteria. Furthermore, AAMC highlights existing resources produced by the Department of Veterans Affairs (VA) to help guide clinicians taking military health histories.

Joining Forces is a national initiative launched by First Lady Michelle Obama and Dr. Jill Biden to improve the health of military service members and their families. Under that banner, AAMC has advocated for improving military cultural competency in patient care, including a November 2013 Joining Forces Wellness Week and Webinar on taking military health histories.

Contact:

Matthew Shick, J.D.
Senior Legislative Analyst, Government Relations
Telephone: (202) 828-0525
E-mail: mshick@aamc.org

Evan Collins, MHA
Specialist, Clinical Operations and Policy
Telephone: 202-828-0552
E-mail: ecollins@aamc.org

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AAMC Submits Comments on NQF Draft Report Recommending Inclusion of Sociodemographic Factors

April 18, 2014— The AAMC April 16 submitted comments  on the National Quality Forum’s (NQF) draft report on sociodemographic status factors and risk adjustment. A key recommendation would change NQF’s policy to allow sociodemographic status to be a factor in the risk-adjustment methodology for certain accountability measures [See Washington Highlights, March 21]. The draft report was produced by an NQF expert panel, which included AAMC Chief Public Policy Officer, Atul Grover, M.D., Ph.D.

The AAMC supported all eight recommendations outlined in the report. The association cited the trend in quality measurement towards the inclusion of complex outcome and resource use measures, and argued that such measures will require a more robust risk adjustment to account for factors that are outside of the provider’s control.

Additionally, the AAMC pointed to the Hospital Readmission Reduction Program (HRRP) as an example of the unintended consequences of not adjusting for sociodemographic variables in a pay-for-performance program: safety-net providers may lose scarce resources necessary to care for vulnerable patients, which potentially entrenches disparities.

The AAMC advocated for one recommendation to be strengthened. The NQF report highlighted that “users of performance measures should assess the potential impact on disadvantaged patient populations and the providers serving them to identify unintended consequences…” In its comments, the association argued that instead, users “must” assess the impact on disadvantaged populations to identify potential inequalities that may arise.

Regarding another recommendation in the report that focused specifically on how measures should be implemented in pay-for-performance programs, the AAMC stated its support and noted that NQF-endorsed measures are not always used as specified. While NQF does not enforce implementation of its measures, it needs to be clear about what an endorsed measure is and how it should be used.

The draft report is available, though the deadline for submitting comments has passed. The comments will be reviewed by the NQF expert panel in May.

Contact:

Mary Patton Wheatley
Director, Health Care Affairs
Telephone: 202-862-6297
E-mail: mwheatley@aamc.org

Scott Wetzel
Senior Specialist, Health Care Affairs
Telephone: 202-828-0495
E-mail: swetzel@aamc.org

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NIH Changes Policy on Research Grant Resubmissions

March 18, 2014— The National Institutes of Health (NIH) April 17 announced a change in policy on resubmissions for research grant applications. For research project grant applications due after April 16, 2014, following an unsuccessful resubmission application, applicants may submit the same idea as a new application for the next appropriate due date.

The policy states that the agency will not assess the similarity of the science in the new application to any previously reviewed submission when accepting an application for review. The new policy, effective immediately, also applies to applications submitted to the Agency for Healthcare Research and Quality (AHRQ).

Until 2009, investigators who had submitted applications for NIH research project grants were permitted two opportunities to revise and resubmit those applications, based on the comments and other feedback provided by the agency’s peer review process. After an extensive reexamination of its peer review procedures, NIH changed the policy to permit only one resubmission for a revised application, moving in effect from “three strikes” to two in terms of the number of opportunities for an application to be funded.

NIH believed that the two strike policy would remove some of the delay in funding meritorious proposals, and in fact, more proposals were subsequently funded after only one review. However, the policy generated concerns with many investigators who believed it simply decreased opportunities for approval of their best considered ideas.

In her blog, NIH Deputy Director for Extramural Research Sally Rockey, Ph.D., explained that a key part of the prior policy was that applications not accepted after two rounds had to be “substantially different in content and scope” to be eligible for later submission as a new application. The new policy permits such applications to be resubmitted in later review cycles.

Additionally, Dr. Rockey noted that the agency was responding to concerns that new or early career investigators carried an extra burden to demonstrate that a later proposal was entirely new and sufficiently different from a prior application. Younger investigators are often intensely focused on particular areas of research, and they have not yet had opportunities to develop the data or experience that generates widely varying approaches for their research proposals. She explained that NIH will monitor the impact, if any, that the policy change has on the number of applications received by NIH. 

Contact:

Stephen Heinig
Director, Science Policy
Telephone: 202-828-0488
E-mail: sheinig@aamc.org

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NQF Releases Draft Report on Episode Groupers

April 18, 2014— The National Quality Forum (NQF) has released a draft report on evaluating episode groupers. The report was developed by a 21-member expert panel comprised of individuals representing various stakeholders, such as payers, providers, and clinicians.

Episode groupers are software tools that support episode-based performance and payment measurement by attributing care to condition-specific or procedure-specific episodes based on the relationship of the health care services to the care of a specific condition. Episode groupers have been developed and used in the commercial payer sector and the Centers for Medicare and Medicaid Services (CMS) intends to develop a publicly available episode grouper for Medicare beneficiaries.

The purpose of this NQF effort is to:

  • Define the characteristics and challenges of constructing episode groupers;

  • Determine the key elements of episode groupers;

  • Establish an initial set of criteria by which episode groupers should be evaluated for NQF endorsement; and

  • Identify implications and considerations for NQF-endorsement of episode groupers.

The panel focus is broad in nature so that the recommended criteria can be applied to any episode grouper submitted to NQF for endorsement. Comments are due by May 13.

Contact:

Evan Collins, MHA
Specialist, Clinical Operations and Policy
Telephone: 202-828-0552
E-mail: ecollins@aamc.org

Mary Patton Wheatley
Director, Health Care Affairs
Telephone: 202-862-6297
E-mail: mwheatley@aamc.org

Scott Wetzel
Senior Specialist, Health Care Affairs
Telephone: 202-828-0495
E-mail: swetzel@aamc.org

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Dr. Yvonne Maddox to Serve as NIMHD Acting Director

April 18, 2014— The National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH) April 15 announced the appointment of Yvonne T. Maddox, Ph.D., as NIMHD Acting Director. Dr. Maddox will succeed John Ruffin, Ph.D., who announced his retirement last month after serving at NIH for 24 years.

Prior to joining NIMHD, Dr. Maddox was the NIH Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Deputy Director. She served as NIH Acting Deputy Director from January 2000 – June 2002 and co-chaired the first NIH Strategic Plan to Reduce and Ultimately Eliminate Health Disparities.

Additionally, Dr. Maddox chairs the Federal SIDS/Sudden Unexpected Infant Death Working Group and the NIH Down Syndrome Consortium. She also has led several other Department of Health and Human Services (HHS) and NIH committees to advance medical research for affected communities to improve their health, including serving as executive director of the HHS Cancer Health Disparities Progress Review Group and co-chair of the HHS Initiative to Reduce Infant Mortality in Minority Communities.

Contact:

Jason Kleinman
Program & Policy Specialist, Government Relations
Telephone: 202-903-0806
E-mail: jkleinman@aamc.org

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On the Agenda in Washington

April 22: PCORI Board of Governors Meeting
12 p.m.; Teleconference/Webinar
The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors will meet via webinar/teleconference. The meeting is open to the public, though no public comment period is scheduled.

April 24: Health IT Standards Committee Meeting
9 a.m.; 10 Thomas Circle N.W., Washington, D.C.
The Office of the National Coordinator (ONC) for Health Information Technology (HIT) Standards Committee will meet to discuss standards implementation specifications and certification criteria for the electronic exchange of health information.

April 29: Senate Appropriations Committee Hearing on Innovation
2:30 p.m.; G50 Dirksen Senate Office Building, Washington, D.C.
The Senate Appropriations Committee will hold a hearing on federal investments in innovation. Witnesses include: National Institutes of Health Director Francis Collins, M.D., Ph.D.; National Science Foundation Director France Cordova, Ph.D.; Office of Science and Technology Policy Director John Holdren, Ph.D.; and Department of Energy Secretary Ernest Moniz. The committee will accept outside witness testimony until April 24.


On the Hill…

April 18, 2014— Rep. Tom Petri (R-Wis.) April 14 announced that he will not seek reelection in 2014 after serving in Congress for 35 years. He is currently a member of the Committee on Education and the Workforce and Committee on Transportation and Infrastructure, where he serves as the chair of the Subcommittee on Highways and Transit.

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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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For More Information

Dave Moore
Senior Director, Government Relations
Telephone: 202-828-0559
E-mail: dbmoore@aamc.org