Last night, the White House announced that President Obama has decided to make a recess appointment for Dr. Donald Berwick to serve as CMS Administrator. 

Dr. Berwick is a pediatrician and professor at Harvard University and the founder of the Institute for Healthcare Improvement. He launched the “100,000 Lives” campaign to reduce the number of deaths attributable to medical errors in hospitals.  He has previously served as Vice Chair of the U.S. Preventive Services Task Force, a member of the Board of Trustees of the American Hospital Association, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality (AHRQ).

The Constitution provides an exception to the Senate confirmation process for nominations. When the Senate is in recess, the President may make a temporary appointment known as a “recess appointment” without Senate approval. President Obama is making the appointment during a recess in the middle of a session, so Dr. Berwick’s appointment will expire at the end of the following session or at the end of the first session of the 112^th Congress. 

President Obama has made 15 recess appointments, not including Dr. Berwick.

Senate Minority Leader Mitch McConnell (R-KY), along with Senators John Barrasso (R-WY), Pat Roberts (R-KS) and Tom Coburn (R-OK), objected to President Obama’s move and noted that confirmation hearings were not scheduled to allow for consideration of the nominee. Senate Finance Committee staff responded that Republicans have urged Leadership to expedite Dr. Berwick’s confirmation hearing and hold it before Supreme Court Justice nominee Elena Kagan’s hearing.

Last week, the House and Senate adjourned for the Fourth of July recess without extending the Medicaid FMAP funding increase or COBRA insurance despite the call of numerous Governors on Congress to extend the enhanced FMAP funding through June 2011. Republican Senators continue to object to extending these provisions unless they are fully offset. Republican Senator Scott Brown of Massachusetts introduced a bill to extend the FMAP funding. The bill would be paid for with unused stimulus funding. However, reapportioning stimulus funding stands little chance of being politically palatable to Democrats. Congressional staff have signaled determination in passing an FMAP extension, perhaps in a supplemental spending bill or Gulf relief legislation.

The House amended and passed a Senate-approved war supplementing spending bill before it adjourned. The House amended the bill to include Senator Herb Kohl’s legislation, the “Preserve Access to Affordable Generics Act,” which would ban agreements between brand name and generic drug manufacturers. Senator Kohl has called such agreements “one of the most egregious tactics used to keep generic competitors off the market leaving consumers with unnecessarily high drug prices.” The Generic Pharmaceutical Association, however, expressed opposition to the amendment noting that such agreements have, at times, allowed generic drugs to come to market before the patents of the name brand drugs expire.

Last week, the Centers for Medicare and Medicaid Services released the 2011 Physician Fee Schedule Proposed Rule. CMS estimated that without Congressional action, physician payments would be cut by 23 percent beginning on December 1 and reduced by an additional 6.1 percent beginning January 1, 2011. Congress is almost certain to have a lame duck session in which Members will pass another short-term SGR fix.

Capital Thinking Radio Show July 1, 2010

If you missed the Capital Thinking Radio Show with Kevin O’Neill last week, listen to the podcast on demand. 

Join us as we examine the hurdles of turning the new health care bill into a reality with advocacy leaders John Jonas and Julie Black.

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius spoke today at the National Partnership for Women and Families luncheon. The Secretary is only the fourth woman to lead the department.

She provided an update on the implementation of the Affordable Care Act (ACA), noting that it is the best woman’s health care bill since Medicare because it gives women more control over their health care. The Secretary stated that the law brings fairness into the marketplace because it prohibits insurance companies from charging women more for insurance than men. She applauded that being a woman is no longer a pre-existing condition. Secretary Sebelius highlighted that ACA limits co-payments for key preventive services. She explained the importance of this provision by noting that early detection of breast cancer yields a 98 percent survival rate.

The Secretary touted President Obama’s Patient Bill of Rights, which reiterates that beginning this fall, insurance companies cannot deny coverage for children who were born with or develop pre-existing conditions, prohibits recessions beginning in September, phases out the annual and lifetime limits, and protects patients’ choice of doctors.

Secretary Sebelius explained that ACA is important for older women, who live longer than men and tend to depend on Medicare in larger numbers. The law will reduce fraud and abuse and close the donut hole.

She stated that health information technology (HIT) is an underpinning of care coordination and management of chronic conditions. The Secretary applauded the President’s investment in HIT that was included in the American Recovery and Reinvestment Act (ARRA).

She concluded that the Affordable Care Act moves toward building a system where women receive the security, flexibility, and quality care that they deserve.

On June 17, 2010, the National Quality Forum (NQF) hosted a webinar focused on the intersection of health information technology (HIT) and quality improvement. 

Dr. Marc Overhage, MD, PhD, Director of Medical Informatics at Regenstrief Institute, reviewed the goal of the Health Information Technology for Economic and Clinical Health Act (HITECH) to improve care and the efficiency of care. He stated that the key to HITECH is the definition of “meaningful use.”  He reported that the Centers for Medicare and Medicaid Services (CMS) is close to issuing its final rule that will establish the definition of meaningful use. He speculated that the Agency will soften the definition of meaningful use in the final rule, but that the proposed and final rules will be very similar. He stated that the Agency’s goals in 2010 are data capture and sharing.  In 2013, the goal is increased data use to improve the quality of care and in 2015 CMS intends to focus on substantially improving outcomes for patients. 

Dr. Overhage described the incentives established in HITECH to encourage physicians to become meaningful users of EHRs.  He stated that the EHR adoption timeline is constructed in a graduated incentive model and that the Federal government hopes that many providers will adopt EHRs early.  He noted that if providers become meaningful user in 2011 and 2012, they will receive the full incentive payment. 

He highlighted the connection between the National Priorities Partnership priorities and the health outcomes policy priorities established in HITECH. He reported that patient and family engagement, population health, safety, and care coordination were common themes. The National Priorities Partnership also identified palliative and end-of-life care and overuse as additional priorities. 

Dr. Overhage shared that Regenstrief has established a Quality Health First® Program that uses HIT to drive performance measurement and quality improvement. The program has incorporated a Medicare demonstration program, which allows Medicare providers to participate along commercial providers and provide incentives.  He explained that providers receive incentive payments based upon their own quality improvement, even if they are the worst performing among providers. In 2009, a 5 percent improvement in quality was reported across the 1,000 primary care providers. 

He stated that NQF is convening the HIT and Quality Committees to: (1) help build the electronic infrastructure to help automate performance measurement; (2) encourage and harmonize information standards; (3) facilitate coordination between quality and HIT communities; and (4) establish quality measurement and clinical decision support to occur in simultaneous fashion.

NQF will host another webinar on July 16 at 12:00 pm Eastern Time focused on quality and leadership.

The Department of Health and Human Services released the Interim Final Rules for Relating to Status as a Grandfathered Health Plan under the Patient Protection and Affordable Care Act.

Peter Orszag, Director of the Office of Management and Budget (OMB), and Rahm Emanuel, White House Chief of Staff, issued a memorandum and guidance to federal agencies directing them to craft a plan to cut their budgets by 5 percent. Dr. Orszag explained in a speech to the Center for American Progress that agencies should identify “their bottom 5 percent performing discretionary programs, as measured by their impact in furthering the agency’s mission.”

The memorandum directs agencies to identify of the programs in the bottom 5 percent in their Fiscal Year 2012 budget requests, which are due to OMB on September 13.  Agencies must include an explanation for why the program is among the lowest performance as it relates to the impact on the agency’s mission, strategic plan, and the President’s initiatives. The memorandum encouraged agencies to identify entire programs to be cut or propose substantial spending reductions that amount to at least 50 percent of a program or subprogram’s budget. 

The guidance document restated President Obama’s pledge to freeze overall discretionary spending through Fiscal Year 2013. Agencies were directed to identify in their budget requests “at least five significant terminations, reductions, and administrative savings initiatives that reduce costs below FY 2011 Budget levels.”  Agencies must provide an in-depth analysis for any programmatic request above FY 2011 levels.   

A Washington Post article reports that President Obama will seek authority to allow the agencies to retain a portion of the savings that they identify. The article notes that the Obama Administration plans to announce additional measures in the coming days designed to reduce fraud and abuse.

The Patient Protection and Affordable Care Act requires the Secretary to establish Accountable Care Organizations (ACOs), which will enable care coordinate among providers, by January 1, 2012. ACOs that meet quality targets and reduce the costs of their patients by coordinating items and services under Medicare Part A and Part B are rewarded with a share of the savings they achieve. Physician groups, hospitals, nurse practitioners and physician assistants, and others can participate in ACOs.

The Centers for Medicare and Medicaid Services (CMS) has relayed that while specific quality performance standards will be determined by the Secretary, ACOs will be measured on clinical processes and outcomes of care, patient experience, and utilization of services. 

In a Frequently Asked Questions document, CMS stated that the Agency will host an Open Door Forum this summary and will post details of the session by June 11 on its website: http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp#TopOfPage.  A Notice of Proposed Rulemaking is expected to be released in the fall.

This week, President Obama sent a legislative proposal to Congress that would give him the authority to rescind any spending approved by Congress. The President’s proposal, the “Reduce Unnecessary Spending Act of 2010,” would allow the Congress to vote without amendment to approve or reject the President’s proposed recessions. 

House Budget Committee Chairman John Spratt (D-SC) is expected to introduce legislation on behalf of the President.

The National Quality Forum (NQF) has requested public and member comments on its plan to establish a Partnership for Applying Measures to Improve Quality.  If the Secretary of Health and Human Services (HHS) assigns NQF with the responsibility to convene multi-stakeholder groups to provide input to the Secretary on the selection of new quality measures as required by the Patient Protection and Affordable Care Act, NQF will proceed with establishing the Partnership. 

NQF envisions that the Partnership would provide input regarding Hospital Compare, the Physician Quality Reporting Initiative (PQRI), the hospital readmissions reduction program, the payment adjustment for hospital acquired conditions, measures for demonstrations (medical homes, accountable care organizations, bundled payments), and public reporting websites.

Any stakeholder who is interested in the quality provisions of the health reform law should take the opportunity to provide NQF with comments, which are due to NQF by June 15, 2010 at 6:00 pm Eastern Time.