Washington Highlights: November
20, 2009
Senate Unveils
Health Care Reform Bill
Contents
Prior Issues
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Senate Majority Leader Harry Reid (D-Nev.) Nov. 18 unveiled health
care reform legislation that would expand coverage to 31 million
uninsured Americans. The Congressional Budget Office (CBO) estimates
94 percent of the nation's population (excluding unauthorized immigrants)
will have health care coverage under the Patient Protection and
Affordable Care Act (H.R.
3590). The bill represents a merger of health care reform legislation
passed by the Finance (S.
1796) and Health, Education, Labor, and Pensions (S.
1679) committees [see Washington
Highlights, Oct. 16].
Sen. Reid hopes to hold the first procedural vote on H.R. 3590 before
the Senate leaves for the Thanksgiving recess. The 10-year $848
billion cost of H.R. 3590 is largely offset by a new excise tax
on high-premium insurance plans and payment reductions for Medicare
and Medicaid providers. CBO estimates that the bill will reduce
the federal deficit by $130 billion over the next ten years.
The Senate package includes an individual mandate for most Americans,
effective 2014. It establishes insurance "exchanges" and
offers subsidies for purchasing coverage. The exchanges include
a public option that would allow for the negotiation of provider
payment rates. Providers may "opt-out" of the public plan,
as may states. Under H.R. 3590, nearly 15 million people will be
newly eligible for Medicaid and the Children's Health Insurance
Program, at an estimated cost of $374 billion over 10 years. Similar
to the previous passed bills, H.R. 3590:
- Redistributes 65 percent of currently unused residency training
slots and directs those slots to hospitals in certain states;
- Establishes a new Center for Medicare and Medicaid Innovation
(CMI) to test innovative payment and service delivery models.
New language in H.R. 3590 references AAMC-supported Healthcare
Innovation Zones (HIZs) as one of the models that may be tested;
- Provides a one-time 0.5 percent Medicare physician payment update
for CY 2010 (costs $11.3 billion);
- Reduces Medicare updates for most providers (saves $192 billion
over 10 years);
- Reduces Medicare and Medicaid disproportionate share hospital
payments (saves $22 billion and $21 billion respectively);
- Establishes new payment policies for hospital readmissions (saves
$7 billion);
- Implements a value-based purchasing program for hospitals (budget
neutral);
- Establishes an Independent Medicare Advisory Board, that would
implement Medicare payment policy changes with limited input from
Congress (saves $23 billion);
- Includes provisions to reauthorize some of the Title VII health
professions and Title VIII nursing education programs; and
- Increases the authorization for the National Health Service
Corps (NHSC) to $1.15 billion in FY 2015.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Len Marquez, Director
AAMC Government Relations
lmarquez@aamc.org
(202) 862-6281
Travis W. Crytzer, Legislative Analyst
AAMC Government Relations
tcrytzer@aamc.org
(202) 828-0418
House Approves Physician Payment Legislation
The House of Representatives Nov. 19 passed (243-183)
AAMC-supported legislation that averts a scheduled 21.2 percent
reduction in Medicare's 2010 physician payments. The Medicare Physician
Payment Reform Act (H.R.
3961) establishes a 1.2 percent update for 2010 (the percentage
increase in the Medicare Economic Index). It also eliminates the
$210 billion sustainable growth rate (SGR) deficit, rebases physician
payments, and establishes two new service-specific target growth
rates [see Washington Highlights,
Nov. 6].
In anticipation of the floor vote, a group of 127 physician organizations
including the AAMC submitted a Nov. 13 letter
urging Speaker Nancy Pelosi (D-Calif.), to ensure swift passage
of H.R. 3961. According to the letter, "Medicine can no longer
support the sort of short-term patches that have been used in the
past to postpone true payment reform." The letter adds that
"swift passage" of the bill will replace a "physician
payment system that is widely acknowledged to be dysfunctional."
The Congressional Research Service (CRS) Nov. 6 issued a report
titled "Medicare Physician Payment Updates and the Sustainable
Growth Rate (SGR) System," which analyzes H.R. 3961, among
other legislation. The report cites the Nov.4 Congressional Budget
office (CBO) cost estimate
that H.R. 3961 would increase direct federal spending by approximately
$210 billion over a 10-year period, but that the modification to
the SGR system may "reduce the likelihood that future expenditures
exceed target expenditures, since the growth rates would be more
generous under this bill than under current law."
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Will Dardani, Constituent Services Specialist
AAMC Health Care Affairs
wdardani@aamc.org
(202) 828-0541
AAMC Testifies at HIT Standards Committee Meeting
AAMC Chief Health Care Officer, Joanne Conroy, M.D., testified
Nov. 19 before the Health Information Technology (HIT) Standards
Committee on teaching hospitals and health systems' experience with
data theft, loss, and misuse. In her remarks, Dr. Conroy highlighted
the unique security issues AAMC members face because of the number
of patients they treat, the number of sites - both inpatient and
outpatient - where they provide health care, the number of individuals
they employ, the students they train, and the clinical research
they conduct. She described approaches members are taking to combat
data theft, including education programs for employees, proactive
monitoring, and two factor authentication for remote users. Dr.
Conroy also emphasized that AAMC members increasingly are concerned
about issues related to the use of portable devices, particularly
by students.
At the Nov. 19 meeting, the committee focused on security challenges
and heard testimony on systems stability and reliability, cybersecurity,
data theft, and building trust. Testimony addressed a wide variety
of stakeholder perspectives and included discussions about how to
balance security and access, creating outcome-based measures for
security standards, and how to address the security not only of
personal health information but also safety-critical information.
The committee also discussed the use to date of the HIT FACA blog
and encouraged the public to continue to contribute to this discussion
through Dec. 1, the last day the public will be able to post to
the blog.
The meeting agenda and all written testimony from the presentations
are available on the HIT Standards Committee Web
site. More detailed summaries of the meetings will be posted
to the AAMC HIT Web
page.
Information:
Lori K. Mihalich-Levin, J.D., Senior Policy Analyst
AAMC Health Care Affairs
lmlevin@aamc.org
(202) 828-0599
AAMC Comments on Clinical Logic for Episode Groupers
The AAMC submitted a Nov. 17 comment letter
to the Centers for Medicare and Medicaid Services (CMS) on defining
"episodes of care" for resource management. CMS has been
researching different methods to measure efficient delivery of care.
"Episodes of care" is one option that allows for the comparison
of resources based on clinically similar conditions. CMS will release
a request for proposal (RFP) asking interested applicants to develop
a transparent, publicly available grouper logic and software specific
to the Medicare population. The agency solicited comments on methodology
considerations and other policy issues at a Nov. 10 listening session
[see Washington Highlights,
Nov. 13].
In its letter, the AAMC states that patient socio-economic status
should be considered in risk adjustment methodology and that patients
with mental health and substance abuse comorbidities should either
be removed from analysis or put into a separate category. In addition,
the AAMC encourages CMS to consider the mission of academic medicine
and to adjust for the impact of teaching residents, conducting research,
and for providing specialized services when comparing episodes.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
Medicare Distributes $92 Million in Incentives
for Physician Quality Reporting
The Centers for Medicare and Medicaid Services (CMS) Nov. 13 announced
that over $92 million in incentives were paid to physicians and
other eligible professionals for successfully reporting quality
data through the 2008 Physician Quality Reporting Initiative (PQRI).
Of the approximately 153,600 professionals who submitted quality
data to CMS, more than 85,000 (55 percent) received a 1.5 percent
incentive on their Medicare Part B allowed charges. The average
incentive amount per professional was over $1,000.
CMS also announced an additional 3,900 professionals would receive
incentive payments for the 2007 PQRI due to technical errors that
were discovered in the 2007 claims analysis process. For the 2007
PQRI, CMS originally paid $36 million in incentives to more than
56,700 professionals. In that year, professionals could only report
quality information for a six-month reporting period and the data
had to be submitted on claims forms.
The 2008 PQRI offered more options for professionals to participate
than in 2007. The number of measures increased from 74 to 119, and
CMS offered the option to report on groups of measures. CMS also
offered a 6-month and 12-month reporting period and allowed reporting
from qualified registries. Nearly 8 percent of the PQRI participants
submitted data through registries, and of those, 96 percent received
incentive payments.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
On the Agenda in Washington
Dec. 2: House VA Committee Hearing on VA Health Care Funding
10 a.m.; 334 Cannon House Office Building
The Full House Committee on Veterans Affairs is scheduled to hold
a hearing
titled "VA Health Care Funding: Appropriations to Programs."
Dec. 3: National Science Advisory Board for Biosecurity Meeting
8:30 a.m.; Bethesda Marriott, 5151 Pooks Hill Rd., Bethesda,
Md.
The National Science Advisory Board for Biosecurity (NSABB) will
meet
for presentations and discussions regarding: (1) Introduction of
new NSABB voting members; (2) federal responses to NSABB reports;
(3) activities of the Working Groups on Outreach and Education and
on International Engagement; (4) synthetic biology and NSABB draft
report on biosecurity issues raised by synthetic biology; (5) public
comments; and (6) other business of the board.
Dec. 4: Meeting of the NIH Advisory Committee to the Director
8:30 a.m., National Institutes of Health, Building 31, Conference
Room 6, 9000 Rockville Pike, Bethesda, Md.
The National Institutes of Health (NIH) Advisory Committee
to the Director will hold a meeting
to discuss the director's report, the Council of Public Representatives
Liaison report, and other pending business.
Dec. 7: Practicing Physicians Advisory Council Meeting
8:30 a.m.; 505-A Humphrey Bldg., 200 Independence Ave. S.W.
The Practicing Physicians Advisory Council (PPAC) will meet
to discuss certain proposed changes in regulations and manual instructions
related to physicians' services, as identified by the Secretary
of Health and Human Services.
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