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Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.
Congress Recesses for August District Work Period
The House and Senate will adjourn July 15 through Sept. 6 for the summer recess and Labor Day holiday. Washington Highlights will resume in September.
House Appropriations Committee Approves HHS Spending Bill
July 15, 2016— In a markup that extended over two days, the House Appropriations Committee July 14 approved 31-19, the fiscal year (FY) 2017 Labor-HHS-Ed appropriations bill. The committee adopted five amendments to the bill approved by the subcommittee one week earlier [see Washington Highlights, July 8].
Committee Chair Hal Rogers (R-Ky.) noted the bill includes a $1.25 billion increase for the National Institutes of Health (NIH), which would be “directed to critical research initiatives, focusing on diseases like Alzheimer’s and pediatric cancer,” and also highlighted the bill’s establishment of an Infectious Diseases Rapid Response Reserve Fund, which would “allow the CDC director immediate access to funds to respond to future emergencies.”
Subcommittee Ranking Member Rosa DeLauro (D-Conn.) offered an amendment to increase NIH funding in the bill by $750 million, for a total $2 billion increase for NIH, with $550 million of the increase directed to the Cancer Moonshot initiative. The amendment proposed to offset the additional NIH funding by designating funds provided in the House bill for the infectious disease reserve fund and for opioid response efforts as emergency funding so they would not count against budget caps.
While the amendment failed on a party-line vote, Subcommittee Chair Tom Cole (R–Okla.) acknowledged the “importance of building on what we accomplished [for NIH] last year and even what [the committee has] proposed this year so far,” adding that he believes the committee will be able to “raise the number that’s already in the base bill substantially, working together across the aisle, because our friends in the Senate have the same goal.” The bill approved by the Senate Appropriations Committee June 9 provides a $2 billion increase for NIH [see Washington Highlights, June 10].
Committee members also discussed NIH funding during an amendment offered by Committee Ranking Member Nita Lowey (D-N.Y.) to provide $1.9 billion in emergency spending for Zika response, which she argued would free up funds under the budget caps to “move even more rapidly in investing in NIH,” in the same spirit as the doubling of the NIH budget between 1999 and 2003.
Chairman Cole agreed with the sentiment and responded, “Let’s be careful about goals because when we reach them, we stop. And what we probably need to do in this area is have a sustained increase over a long period of time...because we want this to become a habit that we almost take for granted.” Emphasizing the strong bipartisan support for medical research, he added, “Senator Blunt has made the point, and I think he’s exactly right, this year is probably more important than last year to get us back into the routine so that last year isn't a one-hit wonder. It’s the beginning of a process.”
Like the amendment offered by Rep. DeLauro, the committee rejected Rep. Lowey’s Zika amendment over concerns by Republican committee members that designating emergency funding outside the budget caps would increase deficit spending.
While funding levels for many programs and provisions in the bill – including an increase for the Children’s Hospital Graduate Medical Education program, a cut to the Agency for Health Care Research and Quality, partially rescinded funding from the Patient-Centered Outcomes Research Trust Fund and the Center for Medicare and Medicaid Innovation, and a prohibition on patient-centered outcomes research – became available one week earlier when the subcommittee released bill text, funding levels for only some programs were included in the committee’s report.
For example, the Title VII Health Professions programs received $294.2 million, which is a 12.1 percent increase above the FY 2016 levels. The substantial increase in funding is due to the transfer of the Behavioral Health Workforce Education and Training (BHWET) program from the Substance Abuse and Mental Health Services Administration to the Health Resources and Service Administration, and the bill provides $50 million for the program. Like the Senate bill, the House bill eliminates the Health Careers and Opportunity Program (HCOP) for the first time since FY 2012.
Democratic members voiced strong concerns over the bill. Specifically, they voiced concerns over the bill’s elimination of funding for Title X Family Planning and the Teen Pregnancy Prevention program. Committee Ranking Member Nita Lowey (D-N.Y.) and DeLauro also raised objections that the bill continues restrictions on gun violence research and prevention. Both offered amendments to remove the restrictions from the bill, but both amendments failed on party-line votes.
Sr. Director, Public Policy & Strategic Outreach
Senate Approval of Opioid Conference Report Sends Bill to the President
July 15, 2016— The Senate July 13 approved, 92-2, the Comprehensive Addiction and Recovery Act of 2016 conference report (H. Rept. 114-669), which the House July 7 approved by a vote of 407-5 [see Washington Highlights, July 8], sending the report to the President’s desk for his signature. Lawmakers negotiated a compromise package between the Comprehensive Addiction and Recovery Act of 2016 (S.524) passed by the Senate on March 10 and a series of bills passed by the House on May 11 and May 12.
While the conference report passed with strong bipartisan support, Democrats in both chambers voiced their concerns with the conference report due to its lack of funding for programs authorized under the bill, and wrote a letter expressing their concerns to Conference Committee Chair Fred Upton (R-Mich.). Furthermore, despite indicating that the President would not sign a bill without additional funds, White House Press Secretary Josh Earnest released a statement stating that the President will sign the bill, but added the President “won’t stop fighting to secure the resources this public health crisis demands.”
The opioid conference report includes provisions related to opioid and heroin abuse prevention, education, recovery, and treatment. For example, there is a provision that would provide grants to states to establish a response plan to opioids, which could include the “education of residents, medical students, and physicians…on relevant prescribing guidelines.”
Additionally, the bill would call for additional evidence-based treatments and interventions as well as the establishment of an interagency task force to review and identify the best practices for pain management. Moreover, the report would create a Medicare “lock-in” program that would limit beneficiaries’, who are at-risk of abuse, choice of prescribers or pharmacies “in order to better monitor their use of these medications.”
Fetal Tissue Panel Issues Interim Report
July 15, 2016— The majority members of the House Select Investigative Panel on Infant Lives July 14 released an interim update on its work investigating the transfer of fetal tissue and related matters. The 88-page report describes the panel’s initial perspectives with respect to financial transactions of abortion providers and the potential impact on health care services. The report also describes the panel’s intent to continue exploring these issues through the remainder of the year.
Additionally, the report includes a section challenging the necessity of fetal tissue in medical research. The AAMC submitted a statement affirming the value of fetal tissue research for the record of the panel’s March 2 hearing [see Washington Highlights, March 4].
Select Panel Chair Marsha Blackburn (R-Tenn.) presented the report to House Majority Whip Steve Scalise (R-La.) at a July 14 press conference, in which he stated that the panel “will continue to have the full support of our leadership team to continue their mission.”
The panel, established under the House Energy and Commerce Committee in October 2015 to investigate allegations of the sale of human fetal tissue for profit, has held two hearings to date [see Washington Highlights, April 22] and has issued both letters of inquiry and subpoenas to several organizations [see Washington Highlights, April 1].
In response to the update, Select Panel Ranking Member Jan Schakowsky (D-Ill.) issued a statement noting, “Their interim report, which Democrats learned about through a press advisory, proves that this Panel needs to be disbanded now, before more lives are put at risk.”
At the press conference, Chairwoman Blackburn indicated that the panel will deliver its final report and complete its work by the end of the year.
Sr. Director, Public Policy & Strategic Outreach
Heather Pierce, J.D., M.P.H.
Sr. Director, Science Policy & Regulatory Counsel
Senate Finance Committee Holds Hearing on MACRA
July 15, 2016— Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt testified July 13 before the Senate Finance Committee on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) and implementation of physician payment reforms.
In his opening statement, Committee Chair Orrin Hatch (R-Utah) outlined MACRA’s goal of streamlining “disjointed incentive programs to reduce the administrative burden on physicians; ensure that metrics on which physicians are assessed are relevant to the patients they treat; provide flexibility to physicians to participate in a way that best fits their practice situation; and, provide an incentive to consider and attempt alternative payment models.”
Ranking Member Ron Wyden (D-Ore.) added, “Medicare payment reform took the important step of engraving in stone the principle of rewarding medical care that provides quality over quantity. For the seniors who depend on the Medicare guarantee, that ought to result in better, more thoughtful health care. That’s the direction that health care is headed in across the country, and Medicare should be leading the way.”
Senators on both sides of the aisle expressed concerns with the ability of small and rural physician practices to prepare and adhere to some of the reporting requirements by Jan. 1, 2017, under the new law. Chairman Hatch specifically asked, "Assuming that CMS releases its final incentive program rules around Nov. 1, physicians are only going to have about two months before the program goes live,” adding, “what options are CMS considering to ensure that this program gets started on the right foot?"
Slavitt explained CMS was open to multiple solutions stating, “Some of the things that are on the table that we are considering include alternate start dates, looking at whether shorter periods could be used, and finding other ways that physicians could get experience with the program before the impact of it really hits them.”
The AAMC recently submitted comments to CMS on the MACRA proposed rule and joined a June 21 letter [see Washington Highlights, July 1] with the American Medical Association (AMA) that suggested “the start date should be moved back so that physicians have time to prepare, have adequate notice of final program requirements and thresholds, a final list of qualified Alternative Payment Models (APMs) is available, and the performance period is closer to when incentive payments will be made. We believe this extra time will also be helpful for vendors, registries, and others to update their systems to accommodate the new program requirements.”
Director, Government Relations
Senior Legislative Analyst
Senate Finance Committee Holds Hearing on Stark Law
July 15, 2016— The Senate Finance Committee held a hearing July 17 to discuss physician self-referral restrictions, otherwise known as the “Stark Law.”
The hearing follows a June 30 white paper released by Chair Orrin Hatch (R-Utah) titled, “Why Stark, Why Now? Suggestions to Improve the Stark Law to Encourage Innovative Payment Models.” The report discusses stakeholder perspectives on how the Stark law is working in practice, and the law’s complexity. The AAMC submitted a comment letter in response to the Senate Finance and House Ways and Means Committees’ request for input [see Washington Highlights, Jan. 29].
In his opening remarks, Chairman Hatch outlined the history of the law, passed in 1989, and its implications today stating, “Because it regulates physicians’ financial relationships, the Stark law has a significant impact on the structure and operation of the healthcare delivery system. Therefore, as we’ve collectively worked to transition our federal health programs toward more value-based payment systems and away from fee-for-service models, one question keeps coming up: In its current form, is the Stark law still necessary?”
Ranking Member Ron Wyden (D-Ore.) focused on finding balance between two key priorities stating, “On one hand, there’s a drive toward bringing doctors and specialists together, promoting coordination, and making health care more efficient whenever possible. On the other hand, there’s a longstanding protection that comes from what’s known as the Stark Law. It says that financial relationships between providers must not influence a patient’s medical care.” He added, “Promoting coordination, and upholding the Stark Law– do not have to come into conflict.”
Johns Hopkins Health System Corporation Deputy General Counsel Peter Mancino, testified on the unique role of the Stark Law in regards to academic medical centers stating, “Now is the time for Congress to modernize the Stark Law to promote fairness and further the goals of MACRA and the Triple Aim. MACRA requires providers to innovate, but we need the tools and the freedom to do so. We urge Congress to act quickly to address our concerns so that the health care industry can transform itself to meet today’s challenges.”
Mancino suggested eliminating the ambiguity of key Stark terms, making Stark penalties more reasonable, and reforming the Stark Law to permit innovative payment methodologies, as ways to improve the Stark Law and allow health care providers to partner with physicians to improve quality and reduce costs.
Other witnesses included: Troy A. Barsky, partner, Crowell & Moring, LLP and Ronald A. Paulus, M.D., president and chief executive officer, Mission Health.
Senior Legislative Analyst
National Academy of Sciences Releases Report on Socioeconomic Status in Medicare Payment Programs
July 15, 2016— The National Academies of Sciences, Engineering, and Medicine July 13 released the third in a series of five reports focused on identifying social risk factors affecting the health outcomes of Medicare beneficiaries and how to account for these factors in the Centers for Medicare and Medicaid Services (CMS)’s payment programs. The reports are mandated by Congress as part of Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act, P.L. 113-185).
In the report, the National Academies highlights a number of social risk factors that could be accounted for in the Medicare value-based payment programs and detailed the pros and cons for each option. These factors include dual-eligibility, education, income, race, and neighborhood deprivation. The report also identifies four options for CMS to consider in accounting for these social risk factors in a payment program: stratified public reporting, adjustment of performance measure scores, direct adjustment of payments to providers, and restructuring the payment incentive design.
CMS currently does not adjust Medicare performance programs to account for social risk factors. Providers have long expressed concerns that not accounting for these factors may disproportionately disadvantage those institutions that serve vulnerable patient populations.
Previous National Academies of Sciences reports focused on defining socioeconomic status (SES), identifying SES factors that impact health outcomes, and identifying best practices of high-performing providers and health plans that disproportionately serve disadvantaged patient populations. The next report, expected in October 2016, will recommend new or existing sources of data for the SES factors previously identified. The final report will synthesize all of the reports and will include recommendations.
Scott Wetzel, M.P.P.
Senior Specialist, Health Care Affairs
On The Agenda
The House and Senate will adjourn July 15 through Sept. 6 for the summer recess and Labor Day holiday. Both chambers will be in session starting Tuesday, Sept. 8.
July 19: PCORI Board of Governors Meeting
The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors will meet via teleconference/webinar. An agenda is available on the PCORI website.
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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Sr. Program & Policy Specialist, Govt Relations
Senior Legislative Analyst