Washington Highlights: July 25,
2008
Contents
Prior Issues
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Senate Postpones Consideration of Supplemental
with NIH Funds
Senate Appropriations Chair Robert Byrd (D-W.Va.) July 22 announced
he would postpone until September consideration of a second FY 2008
supplemental spending package that reportedly includes $500 million
for the National Institutes of Health (NIH).
Championed by Labor-HHS-Education Subcommittee Chair Tom Harkin
(D-Iowa) and Ranking Member Arlen Specter (R-Pa.), the additional
funding would be distributed to NIH institutes and centers on a
pro-rata basis. AAMC President and CEO Darrell G. Kirch, M.D., sent
a July 21 letter
to Senate appropriators, urging support for the additional NIH funding.
In his statement, Chairman Byrd cited a packed Senate schedule
as the basis for postponing consideration of the supplemental, estimated
to include $25 billion worth of relief for national disasters such
as the California wildfires, the Midwest floods, and Hurricane Katrina.
He noted that "the Senate Democratic Leadership is committed
to bringing up the second emergency supplemental appropriations
bill in the Senate in September."
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
House Panel Approves HIT, Privacy Measure
The House Energy and Commerce Committee July 23 amended and approved
a health information technology (HIT) and privacy bill, known as
the "PRO(TECH)T Act" (H.R.
6357). The Committee also debated a series of additional amendments
that were withdrawn with an understanding that they will be clarified
and negotiated as the bill moves forward.
Most of the discussion at the mark-up centered on the privacy provisions
in H.R. 6357, including a requirement that health care providers
using electronic medical records obtain consent to use or disclose
protected health information for "health care operations,"
a broad category including quality assessment and improvement activities,
developing clinical guidelines, reviewing or evaluating provider
performance, conducting residency or other health care training
programs, and creating de-identified health information.
In anticipation of the mark-up, AAMC President and CEO Darrell
G. Kirch, M.D., sent a July 23 letter
thanking Committee Chair John Dingell (D-Mich.) and Ranking Member
Joe Barton (R-Texas), for their leadership in promoting the adoption
of interoperable health information technology, but expressing concern
with how the bill's consent provision would affect health care quality
and safety improvement efforts, among other activities. Describing
the negative impact of such a provision, the letter notes that "this
is an instance in which the right to privacy of an individual patient
conflicts head-on with the duty of health care providers continually
to assure and improve multiple aspects of the care they deliver
to all their patients."
In their opening statements, Reps. Jay Inslee (D-Wash.), Tammy
Baldwin (D-Wis.), and Darlene Hooley (D-Ore.) acknowledged the concerns
of the teaching hospitals in their districts. Rep. Baldwin specifically
noted that it was important not to hinder the efforts of biomedical
researchers.
The committee adopted a handful of amendments, including one by
Rep. Mike Rogers (R-Mich.) to extend eligibility for HIT clinical
education grants to all graduate health professions programs, and
another by Rep. Ed Markey (D-Mass.) that would require the Secretary
of Health and Human Services to develop a "model informed consent"
form that would explain "in plain language" how health
information will be used and disclosed if the patient consents.
Rep. Rogers also offered an amendment that would modify the bill's
requirement that health care providers maintain a log of internal,
non-verbal communications using patients' protected health information.
Arguing that such a requirement would impede quality care by discouraging
physician-to-physician conversations about treatment options, Rep.
Rogers proposed to exempt the accounting of such disclosures for
payment and treatment purposes. Ultimately, Rep. Rogers withdrew
the amendment and agreed to work with Chairman Dingell to clarify
its intent.
The Energy and Commerce Subcommittee on Health approved the bill
June 24 [see Washington Highlights,
June 27]. The bill also has been referred to the Committees
on Ways and Means - which held a July 24 hearing on the subject
and announced plans to introduce a separate bill (see
related story) - and Science and Technology. Additional information
on H.R. 6357 is available on the Energy and Commerce website.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
House Way and Means Subcommittee Discusses HIT,
Privacy
The House Ways and Means Health Subcommittee July 24 held a hearing
on health information technology (HIT) and health information privacy
protections, as Subcommittee Chair Pete Stark (D-Calif.) announced
plans to introduce a bill that he noted was not an effort to slow
down other comparable legislation.
Witnesses included Congressional Budget Office Director Peter Orszag,
Ph.D., who testified that universal HIT implementation could serve
as a "gateway" to savings of nearly $700 billion a year
in health care spending inefficiencies, but only when paired with
aggressive comparative effectiveness and other budget saving efforts.
He also projected that unless Congress plans to provide substantial
subsidies - between $50 billion and $70 billion in start-up costs
- the most effective method to ensure universal implementation is
to penalize providers that do not invest in HIT within a certain
timeframe.
Though the hearing did not focus on specific legislation, some
Members commented on the bill (H.R.
6357) approved by the Energy and Commerce Committee a day earlier
(see related story).
When asked by Rep. Lloyd Doggett (D-Texas) whether she supports
a provision in H.R. 6357 that requires providers to obtain consent
to use or disclose protected health information for health care
operations, privacy advocate Deven McGraw acknowledged concern with
the provision, explaining that it shifts the burden for privacy
protection to the patient and could serve more as a "shield"
than protection. Instead, she continued, the debate should focus
on developing clear, feasible parameters for how providers can and
cannot use protected health information. In her testimony, Ms. McGraw
also urged the committee to "act incrementally" by "filling
the holes" in existing privacy measures such as HIPAA and by
improving enforcement of the most egregious HIPAA violations.
According to Chairman Stark, his forthcoming bill will promote
HIT adoption with financial incentives through Medicare, while protecting
patient privacy by allowing individuals to sue for damages upon
a breach.
Additional information on the hearing, including a full list of
witnesses and written testimony, is available on the committee website.
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
AAMC Endorses Telehealth Measure
AAMC President and CEO Darrell G. Kirch, M.D., sent a July 18 letter
to Rep. Mike Thompson (D-Calif.) endorsing the "Medicare Telehealth
Enhancement Act of 2008" (H.R.
6163). The letter commends the bill's efforts to "enhance
telehealth by removing several barriers that impede the expansion
of telehealth services to rural and other underserved populations,"
and acknowledges the potential of telehealth to "help enable
[the AAMC's] 100,000 teaching physicians and nearly 400 teaching
hospitals and health systems to share their knowledge and expertise
with patients beyond their physical walls."
The legislation would:
- Eliminate the rural designation and allow for Medicare reimbursement
for telehealth services regardless of where the originating site is
located;
- Expand access to telehealth for home health services;
- Create a new grant program through the Health Resources and Services
Administration (HRSA) designed to expand telehealth access to health
care for people in medically underserved areas; and
- Authorize $30 million in telehealth funding for the HRSA program,
the Telehealth Network Grant Program, and the Telehealth Resource
Center Grants.
Informaton:
Travis W. Crytzer, Legislative Analyst
AAMC Health Care Affairs/Government Relations
tcrytzer@aamc.org
(202) 828-0418
HHS Withdraws HPSA Rule
The Department of Health and Human Services (HHS) announced in
the July 23 Federal Register (73
FR 42743) it is withdrawing a proposed
rule that would revise the methodology for designating federal
health professions shortage and medically underserved areas. The
announcement described the receipt of "many substantive comments"
that suggest "HRSA will need to make a number of changes in
the proposed rule." Once the rule has been revised, HHS will
publish in the Federal Register a new Notice of Proposed Rulemaking
to solicit public comments.
HHS originally published the proposed rule Feb. 29, providing a
60-day public comment period. At the urging of many stakeholders,
the comment period was twice extended through June 30 [see Washington
Highlights, June 6].
AAMC President and CEO Darrell G. Kirch, M.D., sent a May 15 comment
letter recommending
that HHS extend the comment period by at least 6 months and convene
a panel of affected stakeholders and community experts for a public
discussion of the proposed new methodology.
Informaton:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Rajeev Sbharwal, Research Analyst
AAMC Center for Workforce Studies
rsabharwal@aamc.org
(202) 828-0979
Senate Approves NHSC Reauthorization
The Senate July 21 approved by unanimous consent a bill (S.
901) that reauthorizes the National Health Service Corps (NHSC)
through FY 2012. The bill authorizes funding from $131.5 million
increasing each year to $185.6 million in FY 2012. The Consolidated
Appropriations Act of 2008 provided $123.5 million for the NHSC.
The bill removes the current provision that requires health centers
and clinics to demonstrate eligibility as a health professions shortage
area every 6 years. The bill also requires that each qualifying
site demonstrate "willingness to support or facilitate mentorship,
professional development, and training opportunities for Corps members,"
and directs the Secretary of Health and Human Services to facilitate
professional relationships among Corps members and other health
professionals. Specifically, the measure emphasizes faculty appointments
at health professions schools, and relationships with hospitals,
academic medical centers, and Title VII Area Health Education Centers
(AHEC) and Health Education Training Centers (HETC).
The reauthorization is part of a package that also reauthorizes
the Community Health Centers Program and the Rural Health Care Programs.
The House June 8 approved a companion measure (H.R.
1343) that did not include the NHSC reauthorization.
Information:
Matthew Shick, Senior Legislative Analyst
AAMC Government Relations
mshick@aamc.org
(202) 862-6116
Senate Appropriations Committee Approves Increased
Funding for FDA
The Senate Appropriations Committee July 17 approved the FY 2009
appropriations bill for the Department of Agriculture (S.
3289), including $2.038 billion for the Food and Drug Administration
(FDA). This represents a $324.6 million (18.9 percent) increase
over FY 2008, and $5.2 million above the amended version of the
President's budget. The President June 9 added $275 million to his
original budget request for the FDA to improve the safety of food
and medical products; modernize FDA's information technology infrastructure;
improve FDA facilities; and expand laboratory capacity for FDA.
The House bill, which includes $2.1 billion for the FDA, was approved
by the Agriculture Appropriations Subcommittee June 19, but the
full committee has not yet considered the bill.
Information:
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
NIH Issues RFA on Women in Biomedical Research
The National Institutes of Health (NIH) published July 14 a Request
for Applications (RFA) to support research on causal factors
and interventions that promote and support the careers of women
in biomedical and behavioral science and engineering. The initiative
will provide $2 million to $3 million to fund up to 8 R01 awards
in FY 2009. The RFA seeks to support research on causal factors
explaining the career patterns of women in biomedical and behavioral
science and engineering. It also aims to test the efficacy of programs
designed to eliminate sex/gender disparities and to promote the
careers of women in these fields. Areas of interest include family
and economic circumstances; institutional/departmental environment
and organizational structure; disciplinary culture or practices;
and issues related to broader social and cultural context.
The initiative is sponsored by the NIH's National Institute of
General Medical Sciences and emerged from the recommendations of
the NIH Working Group on Women in Biomedical Careers, co-chaired
by NIH Director Elias Zerhouni, M.D., and Vivian Pinn, M.D., Associate
Director for Research on Women's Health. The Working Group itself
was created in response to a 2007 National Academies report, "Beyond
Bias and Barriers: Fulfilling the Potential of Women in Academic
Science and Engineering." The receipt date for applications
is Oct. 22.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
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