Washington Highlights: November
14, 2008
Contents
Prior Issues
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AAMC Urges Support for NIH, Medical Education
in Economic Stimulus
AAMC President and CEO Darrell G. Kirch, M.D., Nov. 11 urged
Congress to consider the role that U.S. medical schools and teaching
hospitals play in the nation's fiscal health as lawmakers develop
legislation to stimulate economic recovery.
In an Oct. 29 letter
to Congressional leadership, the AAMC recommends that the stimulus
bill include an additional $1.9 billion for the National Institutes
of Health (NIH), as well as increased support for VA research facilities,
Title VII health professions programs, the National Health Service
Corps, and the country's emergency preparedness and response programs.
Additionally, the letter urges Congress to restore Medicare Capital
Indirect Medical Education payments, preserve long-standing Medicaid
funding for health care safety net providers and graduate medical
education (GME), and raise the cap on Medicare GME training slots.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
CMS releases 2009 Medicare OPPS Final Rule
The Centers for Medicare and Medicaid Services (CMS) Oct. 30 released
the calendar year (CY) 2009 Medicare Outpatient prospective payment
system (OPPS) final
rule on the CMS website. The final rule includes a 3.6 percent
inflation update in base payments for hospital outpatient services
and expands the current inpatient and outpatient quality reporting
programs.
CMS finalized the addition of four claims-based imaging efficiency
measures for use in the hospital outpatient reporting program effective
CY 2010. CMS also finalized the inclusion of the heart attack and
pneumonia 30-day all-cause re-admission measures for the inpatient
reporting program effective FY 2010. CMS has stated its intention
to expand the current hospital acquired conditions (HAC) program
to other settings, most specifically the hospital outpatient setting,
and will be holding a listening session on Dec. 18 to solicit input
and feedback.
The agency finalized its proposal to reduce the payment for separately
payable drugs and biologicals from the average sales price (ASP)
plus 5.0 percent, to ASP plus 4.0 percent. This amount is lower
than the ASP plus 6.0 percent that is paid when these items are
furnished in physicians' offices."
CMS is also finalizing its proposal to create 5 composite Ambulatory
Payment Classification (APC) payment groups for imaging services.
The proposed composite APCs would provide a single APC payment when
two or more imaging procedures using the same imaging modality are
provided in a single session. Currently, hospitals receive separate
payments when two or more imaging procedures are provided in a single
session. Payment for the composite APCs would be calculated from
estimated costs on claims for multiple imaging services provided
in a single session.
In response to comments
from the AAMC and others, CMS rescinded its proposal to set payment
rates for the partial hospitalization program (PHP) services provided
in hospitals based on combined hospital and community mental health
centers (CMHCs) data. Instead, payment rates for the two new hospital
PHP APCs will be based on hospital data only. The new APCs will
distinguish between the costs associated with partial hospitalization
services provided during days with four or more services and those
with three services.
The final rule will be published in the Federal Register November
18.
Information:
Diana Mayes, Specialist
AAMC Health Care Affairs
dmayes@aamc.org
(202) 828-0498
Jennifer Faerberg, Director, Health Care Affairs
AAMC Health Care Affairs
jfaerberg@aamc.org
(202) 862-6221
Energy and Commerce Panel Discusses How Health
Care Can Help the Economy
The House Energy and Commerce Health Subcommittee Nov. 13 held
a hearing
entitled "Treatments for an Ailing Economy: Protecting Health Care
Coverage and Investing in Biomedical Research." The hearing focused
on Medicaid and the National Institutes of Health (NIH).
Several panelists, including Arizona Governor Janet Napolitano
and Center for American Progress Fellow Gene Sperling, strongly
advocated for including in a stimulus package an AAMC-supported
temporary increase in the Federal Medical Assistance Percentage
(FMAP, or "Medicaid Match"). Panelsits also expressed some concerns
about the significant cost of such an increase, with a 14-month,
1-percent increase estimated at $14.7 billion. Mr. Sperling suggested
that Congress waive the "pay-go" requirement for an FMAP increase.
Another panel, including Acting NIH Director Raynard Kington, M.D.,
Ph.D., and Families USA Executive Director Ronald Pollack, M.D.,
strongly emphasized the need for increased NIH funding, and highlighted
the positive impact that NIH grants have on bringing money and jobs
into the local communities. Dr. Kington stressed that funding given
to NIH not only provides human capital to keep biomedical research
globally competitive, but the funding also supports about seven
jobs per grant, equaling over 300,000 jobs.Dr. Pollack pointed out
that jobs created with the support of NIH grants have average salaries
of over $52,000 per year, well above the national average, and that
for every dollar NIH puts into a community, more than two dollars
of increased goods and services was generated.
Subcommittee Chair Frank Pallone (D-N.J.) submitted for the hearing
record an Oct. 30 letter
coordinated by the Ad Hoc Group for Medical Research urging House
Speaker Nancy Pelosi (D-Calif.) to include NIH in the pending economic
recovery package.
The AAMC will be submitting a statement for the hearing record
that reiterates recommendations on NIH and Medicaid outlined in
an Oct. 29 letter
from AAMC President and CEO Darrell G. Kirch, M.D., to Congressional
leadership (see related story).
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Abigail Schopick, Legislative Analyst
AAMC Government Relations
aschopick@aamc.org
(202) 828-0525
Finance Committee Chairman Issues Health Reform
Plan
Senate Finance Committee Chair Max Baucus (D-Mont.) Nov. 12 released
"Call to Action: Health Reform 2009," a 90-page document
outlining his "vision for health care reform." In an introductory
letter, the chairman indicated the document is "intended to
encourage constructive input by policymakers, stakeholders, and
health policy thought leaders."
The document focuses on three core areas: ensuring that all Americans
have access to affordable public or private coverage; improving
the quality and value of health care; and increasing the cost efficiency
and financial sustainability of the health care system. In his report,
Chairman Baucus challenges Congress to "take up and act on
meaningful health reform legislation" in 2009. He adds that
the "urgency of this task has become undeniable."
The Baucus document highlights several issues of particular interest
to medical schools and teaching hospitals:
- The nation lacks the "sufficient supply" of physicians
it needs to "meet the demands of a changing and aging population"
(the document cites AAMC workforce studies).
- Congress should give "serious consideration" to the
Medicare cap on residency slots, graduate medical education (GME)
funding for primary care specialties and non-physician primary
care providers, and the settings in which GME occurs.
- Congress should "increase accountability" for how
Medicare indirect medical education (IME) payments are used by
teaching hospitals.
- There is a need for Congress to "re-examine" Title
VII and Title VIII funding to improve the racial and ethnic diversity
of the nation's health professionals.
- All "gifts and other transfers of value" made to physicians
by drug/device companies must be disclosed.
- Establish a Medicare pilot program to test the "cost and
quality opportunities" of "accountable care organizations"
(ACOs), such as academic medical centers with affiliated/employed
faculty practices. The program should reward ACOs for "improved
quality and efficiency."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Energy and Commerce Chair Outlines Principles
for Health Care Reform
House Energy and Commerce Committee Chair John Dingell (D-Mich.)
sent a Nov. 10 letter to President-elect Barack Obama, pledging
his commitment to work with the incoming administration "to
chart the path forward" on health care reform. In the letter,
Chairman Dingell outlines several "key principles" for
such reform, citing his record of working to "fill gaps and
to improve existing healthcare coverage" in light of "political
realities that have prevented us from enacting universal health
care."
The letter recommends reauthorizing the State Children's Health
Insurance Program (SCHIP) as a first step to universal coverage
and highlights the benefits of health information technology and
increased competition in the insurance market. A fourth recommendation
to improve the public health infrastructure emphasizes the importance
of "addressing workforce issues such as education and training
of health professionals" and "renewed investment in research
and development for cures to chronic and debilitating diseases."
Federal Court Upholds PTO's Rejection of "Business
Methods" Patent
The U.S. Court of Appeals for the Federal Circuit Oct. 30 upheld
the U.S. Patent and Trademark Office's (PTO's) rejection of a patent
on a "business method" that claimed nothing more than
a series of defined mental or cognitive acts. The Court supported
the rejection on grounds that the subject matter of the claimed
"invention" was not eligible for patenting. Section 101
of the patent code states, "Whoever invents or discovers any
new and useful process, machine, manufacture, or composition of
matter, or any new and useful improvement thereof, may obtain a
patent…"
In its ruling on the appeal brought by plaintiffs Bernard L. Bilski
and Rand A. Warsaw, the Court emphasized that a claim must result
in the physical transformation of an article or be tied to a particular
machine or apparatus to be eligible to patent. In March, the AAMC
joined with Eli Lilly in an amicus brief
to the Court citing the implications of this case for medicine
and research. Consistent with the AAMC's argument, the Court's ruling
would continue to permit patents on medical diagnostic test kits,
for example, but would not permit patents that claim methods for
interpreting or correlating (by cognitive acts) the measurements
determined by a diagnostic test.
Notably, in 2006 the U.S. Supreme Court in Labcorp v. Metabolite
declined on technical grounds to review a diagnostic test patent
that effectively claimed such a correlation, but a minority on the
high Court sharply criticized that decision and argued the necessity
of clarifying the criteria for eligible subject matter in assessing
the patentability of diagnostic tests. The AAMC is encouraged that
the Appeals Court decision in the Bilski case will provide this
clarification.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
On The Hill...
Senator Robert Byrd (D-W.V.) Nov. 7 announced that he was stepping
down as chair of the Appropriations Committee. The Senate's oldest
and longest-serving member, Sen. Byrd, has led the Democrats on
the committee for the last 10 years. Sen. Daniel Inouye (D-Hawaii)
will succeed Sen. Byrd as the committee chair in January.
Elected to Other Office
House (2D, 2R)
Luis Fortuño (R-P.R.)
Bobby Jindal (R-La.)
Mark Udall (D-Colo.)
Tom Udall (D-N.M.)
Senate (2D, 0R)
Joseph Biden (D-Del.)
Barack Obama (D-Ill.)
Defeated in General Election
House (4D, 13R)
Nancy Boyda (D-Kan.)
Don Cazayoux (D-La.)
Steve Chabot (R-Ohio)
Thelma Drake (R-Va.)
Phil English (R-Pa.)
Tom Feeney (R-Fla.)
Robin Hayes (R-N.C.)
Ric Keller (R-Fla.)
Joe Knollenberg (R-Mich.)
Randy Kuhl (R-N.Y.)
Nick Lampson (D-Texas)
Tim Mahoney (D-Fla.)
Marilyn Musgrave (R-Colo.)
Jon Porter (R-Nev.)
Bill Sali (R-Idaho)
Christopher Shays (R-Conn.)
Tim Walberg (R-Mich.)
Senate (0D, 3R )
Elizabeth Dole (R-N.C.)
Gordon Smith (R-Ore.)
John Sununu (R-N.H.)
Defeated for Other Office
House (1D, 3R)
Tom Allen (D-Maine)
Kenny Hulshof (R-Mo.)
Steve Pearce (R-N.M.)
Heather Wilson (R-N.M.)
Defeated in Primary
House (0D, 3R)
Chris Cannon (R-Utah)
David Davis (R-Tenn.)
Wayne Gilchrest (R-Md.)
Retiring
House (3D, 23R)
Bud Cramer (D-Ala.)
Barbara Cubin (R-Wyo.)
Tom Davis (R-Va.)
John Doolittle (R-Calif.)
Terry Everett (R-Ala.)
Mike Ferguson (R-N.J.)
Vito Fossella (R-N.Y.)
David Hobson (R-Ohio)
Darlene Hooley (D-Ore.)
Duncan Hunter (R-Calif.)
Ray LaHood (R-Ill.)
Ron Lewis (R-Ky.)
Jim McCrery (R-La.)
Mike McNulty (D-N.Y.)
John Peterson (R-Pa.)
Chip Pickering (R-Miss.)
Deborah Pryce (R-Ohio)
Jim Ramstad (R-Minn.)
Ralph Regula (R-Ohio)
Rick Renzi (R-Ariz.)
Tom Reynolds (R-N.Y.)
Jim Saxton (R-N.J.)
Tom Tancredo (R-Colo.)
Jim Walsh (R-N.Y.)
Dave Weldon (R-Fla.)
Jerry Weller (R-Ill.)
Senate (0D, 5R )
Wayne Allard (R-Colo.)
Larry Craig (R-Idaho)
Pete Domenici (R-N.M.)
Chuck Hagel (R-Neb.)
John Warner (R-Va.)
Appointed to Senate
House (0D, 1R )
Roger Wicker (R-Miss.)
Resigned
House (2D, 2R)
Richard Baker (R-La.)
Dennis Hastert (R-Ill.)
Marty Meehan (D-Mass.)
Albert Wynn (D-Md.)
Senate (0D, 1R )
Trent Lott (R-Miss.)
Died
House (4D, 3R)
Julia Carson (D-Ind.)
Jo Ann Davis (R-Va.)
Paul Gillmor (R-Ohio)
Stephanie Tubbs Jones (D-Ohio)
Tom Lantos (D-Calif.)
Juanita Millender-McDonald (D-Calif.)
Charlie Norwood (R-Ga.)
Senate (0D, 1R)
Craig Thomas (R-Wyo.)
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