Washington Highlights: July 2, 2009
AAMC Urges CMS to Rescind Capital IME Elimination
in Inpatient Comment Letter
Contents
Prior Issues
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In its June 30 comment letter
on the Medicare hospital inpatient proposed rule, the AAMC urged
the Centers for Medicare and Medicaid Services (CMS) to rescind
a regulation that would eliminate capital indirect medical education
(IME) payments scheduled to occur on Oct. 1. The elimination would
result in approximately $380 million in lost payments to teaching
hospitals annually.
In other areas, the AAMC also urged CMS to reduce a proposed 1.9
percent cut to the update factor (as a result of perceived coding
improvements). The letter also urges CMS not to finalize a reduction
to the "labor-related" share to which a hospital's area
wage index applies. Reducing the labor-related share would result
in lower payments to most teaching hospitals because of their higher
wage index values. The AAMC also opposed the proposal to increase
the outlier payment threshold which would reduce outlier payments
for teaching hospitals that treat high-cost patients.
On the graduate medical education (GME) front, the AAMC urged CMS
to rescind a purported "clarification" of when a residency
program is considered "new" when a nonteaching hospital
begins training residents and is in the process of establishing
its Medicare resident cap level. The letter states that not only
is the "clarification" ambiguous, but also that the current
regulatory definition - which allows the accrediting bodies to determine
when a program is new - is appropriate and should be endorsed by
CMS in the final rule.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
AAMC Submits Comments to HIT Policy Committee
on "Meaningful Use" Matrix
The AAMC June 25 submitted to the Office of the National Coordinator
for Health Information Technology (ONC) a comment letter
urging the Health Information Technology Policy Committee to refine
its proposed definition of "meaningful use" and to consider
the essential role teaching hospitals and faculty practices will
play in achieving widespread use of electronic health records (EHRs).
At the full committee's June 16 meeting, the committee's "meaningful
use" workgroup released and solicited comments on a draft document
defining what it means to be a "meaningful user" of an
EHR [see Washington Highlights,
June 19].
In the comment letter, the AAMC indicates its support for "the
establishment of initial reporting measures that are achievable
by large numbers of hospitals and physicians by 2011 or 2012; increasing
the requirements incrementally over time; and ensuring that all
measures are consistent with quality reporting programs already
established by CMS." The AAMC also emphasizes that requirements
related to qualifying as a "meaningful user" of EHRs must
not create impediments to comparative effectiveness and other research.
The letter expresses concern about many ambiguities in the measures
listed in the proposed matrix,
including questions about how the measures are defined, their applicability,
and the ability of hospitals and eligible professionals to collect
and report data required for each measure.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
CMS Releases 2010 Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) July 1 released
its proposed
rule for the Medicare 2010 Physician Fee Schedule. CMS estimates
the update for physician services will decrease by 21.5 percent
from calendar year 2009. The current update formula is based on
a statutory formula that calculates targets for physician spending.
The formula has produced negative updates since 2002; however, from
2004-2009, Congress approved a series of legislation that prevented
the cuts from being enacted. While CMS cannot modify the formula,
it is proposing to use its authority to remove physician administered
drugs from the update calculation. This action does not impact 2010
rates, but does reduce the number of years physicians are projected
to receive a negative update.
The rule also makes several suggestions to modify payments, including
a proposal to no longer pay for consultations and to use new practice
expense data. CMS estimates the payment changes, without considering
the negative update, may shift total allowed charges to specialties
by as much as negative 24 percent to positive 8 percent.
The rule makes several suggested changes to the Physician Quality
Reporting Initiative (PQRI) and the Electronic Prescribing Incentive
Program, such as including a group reporting option and allowing
data submission from electronic health records.
The 60-day comment period ends on Aug. 31. The AAMC will be submitting
comments.
Information:
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
HHS Council, IOM Release Comparative Effectiveness
Reports
Two advisory bodies released reports on comparative effectiveness
research (CER) authorized under the American Recovery and Reinvestment
Act (ARRA, P.L.
111-5).
The Federal Coordinating Council for Comparative Effectiveness
Research (FCCCER) June 29 published its "Report
to the President and Congress." The report provides the definition
of CER that the Department of Health and Human Services (HHS) has
said will guide allocation of $700 million in ARRA CER funds for
the Agency for Healthcare Research and Quality (AHRQ) and the National
Institutes of Health (NIH). The council also fulfilled its ARRA-mandated
responsibilities to describe current Federal activities in CER and
to make recommendations on how the HHS Secretary should spend an
additional $400 million in ARRA funding to accelerate the development
and dissemination of CER.
The report advises that "the primary investment for this funding
should be data infrastructure" and notes that these efforts
in data infrastructure could include "linking current data
sources to enable answering CER questions, development of distributed
electronic data networks and patient registries, and partnerships
with the private sector." The AAMC testified
before the council April 14 [see Washington
Highlights, April 17].
Following the FCCCER report, the Institute of Medicine (IOM) Committee
on Comparative Effectiveness Research Prioritization June 30 published
its ARRA-authorized report
to establish a list of research questions that would have the highest
priority for study. The IOM study also will inform use of the aforementioned
$400 million in ARRA funds under the HHS Secretary's discretion.
Prepared with extensive stakeholder input (such as public testimony
from multiple stakeholders, including AAMC,
and input from 1,758 respondents to a web questionnaire) the report
offers a list of 100 priority topics relevant to CER. Included among
the top 25 are the following:
- Compare the effectiveness of treatment strategies for atrial fibrillation
including surgery, catheter ablation, and pharmacologic treatment;
- Compare the effectiveness of primary prevention methods, such as
exercise and balance training, versus clinical treatments in preventing
falls in older adults;
- Compare the effectiveness of upper endoscopy utilization and frequency
for patients with gastroesophageal reflux disease;
- Compare the effectiveness of dissemination and translation techniques
to facilitate the use of CER by patients, clinicians, payers, and
others; and,
- Compare the effectiveness of comprehensive care coordination programs,
such as the medical home, and usual care in managing children and
adults with severe chronic disease.
By July 30 the HHS Secretary (jointly with the AHRQ and NIH Directors)
is to provide the House and Senate Committees on Appropriations
a fiscal year 2009 operating plan for all the ARRA funds allocated
for CER.
Information:
Eugene Rich, M.D., Scholar in Residence
AAMC Biomedical and Health Sciences Research
grich@aamc.org
(202) 828-0549
On the Hill
Incumbent Sen. Norm Coleman (R-Minn.) June 30 conceded to Democrat
Al Franken after the Minnesota Supreme Court unanimously ruled Mr.
Franken should be certified the winner of the contested Senate election.
The seat has been vacant since the beginning of the 111th Congress,
as the pair requested recounts of Nov. 4 election results that were
separated by a few hundred votes. The Democratic victory brings
the number of total Democrats in the Senate to 58; including two
Independents who caucus with Democrats, the party can avert Republican
filibusters with a 60-vote majority.
On the Agenda in Washington
July 6: Senate HELP Committee to Mark Up Health Care Reform
Legislation
Time TBD, 325 Russell Senate Office Building
The Senate Health, Education, Labor, and Pensions (HELP) Committee
is scheduled to continue considering the "Affordable Health
Choices Act."
July 6: Senate Military Construction and Veterans Affairs
Appropriations Subcommittee to Mark Up FY 2010 Bill
Time TBD, Location TBD
The Senate Military Construction and Veterans Affairs Appropriations
Subcommittee is tentatively scheduled to mark-up draft FY 2010 appropriations
for the Department of Veterans Affairs (VA) with full committee
consideration scheduled for July 7.
July 10: House Labor-HHS-Education Appropriations Subcommittee
to Mark Up FY 2010 Bill
Time 9 a.m., Location 2358-C Rayburn Office Building
The House Labor-HHS-Education Appropriations Subcommittee is scheduled
to consider its FY 2010 spending bill, with full committee consideration
tentatively scheduled for July 14.
July 14-15: ONC HIT Policy Committee's Certification/Adoption
Workgroup to Hear Testimony on the Certification Process
Time 9 a.m. - 4 p.m. on July 14, 9-10 a.m. on July 15; Park Hyatt
Washington Hotel, 24th and M Streets NW
The Certification/Adoption Workgroup is scheduled to hear testimony
from stakeholder groups, including purchasers, vendors, and users,
on the certification process.
July 16: ONC HIT Policy Committee to Discuss Definition of
"Meaningful Use"
Time 10 a.m. - 2 p.m., Park Hyatt Washington Hotel, 24th and
M Streets NW
The HIT Policy Committee will discuss the draft definition of "meaningful
use" as modified since its June meeting.
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