Tag Archives: Health Care Reform

Capital Thinking Podcast

Last week, as the Senate remained in session to finish up some last-minute business before the August recess, Majority Leader Harry Reid and Washington Senator Patty Murray led an effort to pass a $26.1 billion state-aid package. The measure, in the form of a substitute amendment to the Federal Aviation Administration reauthorization bill, provides $16.1 billion to state governments to put towards their Medicaid expenses. It accomplishes this by extending the increases in the Federal Medical Assistance Percentages (FMAP) for a total of six months, a provision that originated in the stimulus bill.

Republican Senators Susan Collins and Olympia Snowe provided crucial votes for the majority, enabling them to suspend debate and ultimately win passage on the amended bill. The Congressional Budget Office scored the bill as being deficit-neutral over the ten year window in part to a number of revenue-raising provisions including cuts in the food stamp program and international tax credits, as well as recessions to a wide variety of other programs. Although many of these cuts drew criticism, the bill is being praised by many states that are desperately in need of the Medicaid funds.

In wake of the Senate’s passage of the bill, House Democratic leadership announced that it would be calling members back into session this week in order to consider the legislation. House Majority Leader Steny Hoyer announced that the House will meet in pro forma session today and again at 10 a.m. on Tuesday to “vote on the bill and send it to the president for his signature.” Although many members may be reluctant to vote for another spending measure in such proximity to the upcoming elections, the fact that both of the major provisions in the bill have already been passed through the House on two separate occasions bodes well for its chances this time around.

After the final vote on the Medicaid bill, the Senate was also able to achieve passage of Senator Blanche Lincoln’s bill to reauthorize federal children’s nutrition programs, as well as a prescription drug disposal bill. Senators are scheduled to return to Washington on September 13, and will begin consideration of competing amendments to a small business bill soon thereafter. The amendments, offered by Senators Mike Johanns and Bill Nelson, would adjust IRS vendor-purchase tax reporting requirements included in the health care overhaul law. In addition, the Johanns amendment would eliminate a preventive care trust fund and decrease the requirements for mandatory health coverage beginning in 2014.

Last week also saw the release of the annual Medicare and Social Security Trustees Report, which depicted an overly optimistic view of the future of Medicare, although the validity of that report has been questioned given that the authors were all members of the current administration.

State challenges to the health care reform law also received a boost last week as a federal court rejected the administration’s request to dismiss the Virginia lawsuit questioning the law’s constitutionality. Additionally, voters in Missouri overwhelmingly supported a measure to repeal the individual mandate created in the reform law, becoming the first state to overturn a central element of the law. This could be the first in a string of such actions taken by individual states in the coming months, as there continues to be growing anxiety over the implementation of state-based insurance exchanges.

Capital Thinking Podcast

On June 24, the House passed the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” which will increase Medicare reimbursement to physicians by 2.2 percent through November 30, 2010.  President Obama signed the legislation into law on June 25.  Amy Hall, Director of the Office of Legislation at the Centers for Medicare and Medicaid Services (CMS) issued a notice to Hill staff explaining that Medicare physician “claims containing June 2010 dates of services which have been paid at the negative update rates will be reprocessed as soon as possible.”  The notification indicated that contractors have been instructed to stop processing claims with the 21 percent cut and to hold claims for services provided in June until the 2.2 percent update is loaded into the claims processing systems.

After eight weeks of consideration of various versions of the “American Jobs and Closing Tax Loopholes Act of 2010” (H.R. 4213) that would extend the Medicaid FMAP funding increase, COBRA insurance, and unemployment benefits, the Senate continues to be in a holding pattern.  Senate Majority Leader Harry Reid most recently failed to get 60 Senators to support cloture on June 24.  Senator Ben Nelson voted with Republicans to block the measure.   The majority has not signaled whether it will try to pass another version this week, but it is the last week Congress is in session before the week-long July 4th recess.

HHS has two major deadlines mandated by the health reform law, the Affordable Care Act, this week – the Department must establish high-risk pools and launch a health insurance web portal by July 1.  Thirty-one states have agreed to run their own high-risk pools, while 20 states will have pools administered by the federal government.

This week the House Education and Labor Committee will hold a hearing on H.R.5504, the “Improving Nutrition for America’s Children Act.”  The bipartisan bill aims to improve the meals children eat both in and out of schools, as well as support community efforts to reduce childhood hunger.  Additionally, the legislation establishes nutrition standards for all foods sold in schools.  The Senate Agriculture Committee has already marked-up its version of a child nutrition reauthorization bill, which awaits floor time.

MedPAC Recs Revisited

On Wednesday, June 23, 2010, the House Energy and Commerce Subcommittee on Health held a hearingentitled “MedPAC’s June 2010 Report to Congress:  Aligning Incentives in Medicare.”  The hearing examined the findings and recommendations proposed in the report submitted by the Medicare Payment Advisory Commission (MedPAC) to Congress on June 15, 2010.

MedPAC Chairman Glenn Hackbarth testified that the Commission has offered 26 recommendations in two reports to Congress this year.  He highlighted areas where MedPAC commissioners have reached strong consensus, such as the unsustainability of Medicare and the need to look for ways to slow the growth rate of expenditures, while improving access and quality.  He stated that there needs to be consistent pressure applied to all health care services to look for ways to change relative values of payments and opportunities need to be examined that signal the type of care beneficiaries need and to reward that type of care.  As an example, he highlighted the medial home concept.  Additionally, Chairman Hackbarth stated that there still needs to be a robust and value-focused Medicare Advantage (MA) program because private plans have the ability to provide care in ways that traditional Medicare does not.

He explained that it is important to reform how Medicare pays for Graduate Medical Education (GME).  Chairman Hackbarth stated that the Commission believes the GME system is the envy of the world, but the current system is not consistently producing physicians that the system needs to move towards a value-based health system.  He noted two types of deficits in the system: 1) the mix of physicians being produced (i.e. lack of racial and ethnic diversity; and 2) content of training, evidence-based medicine, team coordination, or shared decision making is not focused on.  Chairman Hackbarth stated his support for The Accreditation Council for Graduate Medical Education (ASCGME) for working on an outcomes project to refocus training on new skills and a focus on higher value health care, but urged rapid movement on implementing value-based standards.

Republican Members of the Committee largely used the hearing as a platform to air its grievances about the health reform law.  Chairman Waxman described the Republican comments as “propaganda.”

The majority of members were concerned that MedPAC’s recommendation to restructure GME funds would actually take money away from teaching hospitals.  Chairman Hackbarth reiterated that MedPAC was not recommending that money be taken away from hospitals, but that greater accountability be established for the funds.  Specifically, MedPAC recommended that the GME funds move away from being contingent upon fee-for-service and move towards value-based care.  He stated that the proposed standards for value-based GME payments would take effect in three years, which would give institutions time to conform.  Chairman Hackbarth declared that  Medicare could be the lever for this change.

Rep. Donna Christensen (D-VI) stated that when CMS institutes a least costly alternative (LCA) policy, providers often face a financial loss when they prescribe a product that is more expensive.  She asked to the extent that Congress grants CMS explicit authority to institute LCA policies for drugs and biologics, what safeguards does MedPAC recommend so that access to medically needed therapies are appropriately observed.  Chairman Hackbarth stated that least costly alternative policies and reference pricing need to be informed by the best clinical evidence and the process needs to be transparent where all interested parties have the opportunity to present information to CMS.  He noted that MedPAC reported that it would be advantageous to give CMS and the Secretary of HHS more flexibility to execute these policies, but it does not mean abdication by Congress.  Chairman Hackbarth noted that Congress could reserve the right override policies.

Rep. Gene Green (D-TX) inquired whether there will be a problem within the Agency for the newly created Center for Medicare and Medicaid Innovation (CMI).  Chairman Hackbarth explained that the health reform law took a major step in giving the Secretary broader authority for testing new ideas in Medicare, but that in order to meet the challenges that Medicare faces, CMS will need to change the process for testing new ideas.  He noted that currently innovation is painfully slow, but that the health reform law could accelerate the process.  Chairman Hackbarth stated that his greatest concern is that resources will be needed to implement successful demonstrations. He also asked about self-referral and imaging services.  Chairman Hackbarth stated that there is variability among the different types of imaging services, but that the combination of physician ownership, fee-for-service, and mispricing of services leads to over-utilization.

Extending The Extenders Package

This week the Senate will resume consideration of the “American Jobs and Closing Tax Loopholes Act” (H.R. 4213), a substitute amendment released by Senate Finance Committee Chairman Max Baucus. The legislation would provide a 2.2 percent update to physicians for the remainder of 2010 and a 1 percent increase in 2011 bill at a cost of $144 billion. The key difference in the health provisions of the House and Senate extenders legislation is that the Senate version includes a six-month extension through June 30, 2011 of the enhanced Federal Medicaid Assistance Percentages (FMAP) rate. Senate Republicans introduced an alternative package that reduces the deficit by $55 billion. The amendment extends the “doc fix” an additional year and provides a 2 percent increase in reimbursement levels for 2010, and additional 2 percent increases in both 2011 and 2012.  Other potential amendments filed include an extension of COBRA benefits for unemployed worker health insurance, and adjustments to the 340B inpatient discount program.

The Administration continues to promote the effects of the new health care reform law across the country. President Obama hosted a town hall meeting to announce the mailing of $250 checks to assist seniors whose drug coverage found them in the “dount hole” causing high out-of-pocket costs for prescription drugs.

Chairman of the House Education and Labor Committee George Miller introduced the House’s version of a child nutrition reauthorization bill, the “Improving Nutrition for America’s Children Act.” The legislation would authorize the Department of Agriculture to set nutrition standards for all foods sold or served at schools, as well as raise reimbursement rates for schools that meet higher nutritional standards, and improved food safety requirements for schools meals programs. Additionally, it aims to improve program administration, support services and program access and modernize the WIC program by extending period of certification for children, increasing support for breastfeeding, and transitioning from paper food vouchers to an electronic benefit program. Chairman Miller stated that the legislation mirrors key investments proposed by President Obama and First Lady Michelle Obama in her “Let’s Move” initiative, including reducing childhood obesity and improving school wellness. The Senate version has already been considered by the Senate Agriculture Committee and awaits floor time.

This week, the Health Subcommittee and the Oversight Subcommittee of the House Ways and Means Committee will hold a joint hearing on reducing fraud, waste and abuse in Medicare on Tuesday, and the Health Subcommittee of the House Energy and Commerce Committee will hold a hearing titled “NIH in the 21st Century: The Director’s Perspective” also on Tuesday.

CMS Releases FAQ Document Regarding ACOs

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.

Capital Thinking Podcast

After a fairly quiet Congressional recess, the Senate is expected to address pending cuts to physicians that treat Medicare patients when they return this week.  Before Congress left town, the House voted to postpone the 21 percent payment cut for 19 months.  However, other health care benefits, such as an extension of COBRA, which helps unemployed individuals retain their former employer’s health insurance, and enhanced federal payments to states for Medicaid were removed from the bill prior to House passage.  Conservative Democrats voiced concern over the provisions because they added billions of dollars to the deficit.

HHS Secretary Kathleen Sebelius announced the availability of $60 million in Affordable Care Act grants to states and communities to help individuals and their caregivers better understand and navigate their health and long-term care options.  The Administration on Aging and the Centers for Medicare & Medicaid Services will work collaboratively towards an  integrated approach that focuses on the unique needs of seniors, disabled Americans and their caregivers as they seek health care and long-term care.  Funds will be available to states, area agencies on aging, State Health Insurance Assistance Programs, and Aging and Disability Resource Centers.

The Congressional recess did spark debate within the blogosphere over a New York Times article that critiqued the Obama Administration’s use of data from the Dartmouth Atlas Project, an influential research body that has demonstrated geographic variations in the amount of care that hospitals and doctors provide.  The article suggested that the research was only a map of the quality of care provided across the country and could not be used to justify wasteful spending or inefficient care in the health care system as a whole.  Jonathan Skinner and Elliot Fisher, leaders of the Dartmouth Project disputed the Times article stating that it had misrepresented the facts.

Capital Thinking Podcast

Congress to Consider Extenders Legislation This Week

This week, the House and Senate are expected to consider and vote on the “American Jobs and Closing Tax Loopholes Act” (H.R. 4213). House Ways and Means Committee Chairman Sandy Levin and Senate Finance Committee Chairman Max Baucus released the tax extenders legislation last week, which includes several health care provisions, including a six-month extension of the temporary increase in Federal Medicaid Matching Rate and extension of COBRA premium subsidy for individuals terminated on or before December 31, 2010. The bill would also provide an update to physicians for the remainder of 2010 and 2011. Payment rates would increase in 2012 and 2013 if spending growth is within reasonable limits. The bill provides an extra allowance for primary and preventive care in 2012 and 2013.

IRS Issues Guidance on Therapeutic Discovery Project Program

The Administration continues to rollout health reform regulations. Last week, the Internal Revenue Service released guidance on the Therapeutic Discovery Project Program that was established in the Patient Protection and Affordable Care Act. The health reform law authorized a two-year tax credit designed to encourage investments in new therapies to prevent, diagnose, and treat chronic diseases. Firms with 250 employees or less could receive up to 50 percent of the cost of biomedical research up to a maximum credit of $5 million. Applications for the credit are due on July 21, 2010. The IRS will make determinations of eligibility for credits no later than October 29, 2010.

National Commission on Fiscal Responsibility Reconvenes

The National Commission on Fiscal Responsibility will convene for its second meeting, this time on the Hill, on Wednesday. The meeting will be webcast at www.whitehouse.gov/live. The Commission has issued a request for comments and ideas to address the country’s fiscal challenges. Comments can be emailed to commission@fc.eop.gov and will be part of the public record.

NQF Seeks Comments on Partnership for Applying Measures to Improve Quality

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.


GAO Seeks Nominations to Board of Governors of the Patient-Centered Outcomes Research Institute

On Friday, the Government Accountability Office (GAO) announced that it is accepting letters of nomination for the Board of Governors of the Patient-Centered Outcomes Research Institute (PCOR).

The Patient Protection and Affordable Care Act outlines the qualifications to serve on the Board.  It requires that the Board members bring a range of perspectives and have scientific expertise in clinical health sciences research, including epidemiology, decisions  sciences, health economics, and statistics.   

Nominations are due on June 30, 2010.