Washington Highlights: December
19, 2008
Contents
Prior Issues
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AAMC Outlines Policy Priorities for Presidential
Transition
AAMC President and CEO Darrell G. Kirch, M.D., is submitting to
President-elect Barack Obama and his transition team an outline
of the association's policy priorities
"to help fashion and implement solutions that will strengthen
the health of our nation and its commitment to serving the public
good."
The document provides an overview of academic medicine and acknowledges
AAMC-member institutions' "significant role in the U.S. health
care system," given their contribution to educating and training
the physician workforce, providing quality health care, and discovering
new knowledge through research. For example, the book notes that
AAMC-member institutions provide a disproportionate share of all
charity care. The document also highlights AAMC-members' substantial
commitment to biomedical and other health care research; the document
reports that the National Institutes of Health (NIH) invests nearly
half of its $29 billion budget at medical schools and teaching hospitals.
The book organizes recommendations for the incoming administration
- such as "predictable, regular expansion of the nation's investment
in medical research," sustained support for graduate medical
education through the Medicare program, and principles for health
care reform - in four broad categories:
- Academic Medicine and Health of the Nation;
- Medical Education;
- Medical Research; and,
- Health Care
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Atul Grover, Director, Government Relations
AAMC Health Care Affairs/Government Relations
agrover@aamc.org
(202) 828-0666
AAMC Urges NIH Funding in Stimulus
The AAMC joined with nearly 200 patient groups, scientific societies,
research organizations and companies in a Dec. 16 letter
to President-elect Obama endorsing a recommendation to include at
least $1.2 billion in NIH funding in any immediate economic-stimulus
effort, and to include this funding in the base for subsequent budget
years.
The letter states, "Research contributes to the economic strength
of the nation by creating skilled jobs in communities nationwide,
new products, and improved technologies." The letter also notes,
"The recent history of the NIH budget has hindered scientific
discovery and is limiting the capacity of a key engine for today's
innovation-based economy."
The groups also called on the President-elect to appoint a permanent
NIH director "who understands the complexity and breadth of
NIH's mission and who can help deploy scientific research investments
wisely for maximum economic and health benefit."
The letter was organized through the Ad Hoc Group for Medical Research,
which the AAMC cosponsors.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
AAMC Comments on Physician Value Based Purchasing
The AAMC submitted a Dec. 16 comment letter
to the Centers for Medicare and Medicaid Services (CMS) on issues
regarding physician value-based purchasing (PVBP). Among the many
comments submitted, the AAMC stated that any PVBP program should
consider the mission of academic medicine and should adjust for
the impact of teaching residents, conducting research, and providing
specialized services.
The "Medicare Improvement for Patients and Providers Act of
2008" (P.L.
110-275) requires CMS to present a Physician Value Based Purchasing
Plan to Congress by May 2010. To start the discussion, CMS released
an issues paper and hosted a listening session on Dec. 9 [see Washington
Highlights,
Dec. 5]. CMS is asking for input on the PVBP objectives, assumptions,
and design principles. In addition, CMS seeks input and feedback
on how the program should be designed and implemented. As such,
CMS poses many questions throughout the paper in the broad topic
areas of measures, incentive structure, data strategy and infrastructure,
and public reporting.
Information:
Mary Patton, Senior Specialist
AAMC Health Care Affairs
mpatton@aamc.org
(202) 862-6297
HHS Issues "Provider Conscience Regulation" Final
Rule
The Department of Health and Human Services (HHS) Dec. 19 issued
a final
rule, "Ensuring that Department of Health and Human Services
Funds Do Not Support Coercive or Discriminatory Policies or Practices
in Violation of Federal Law." The rule grants HHS the authority
to consider all legal options, including termination of funding,
for health care entities that fail to provide necessary accommodations
for employees, trainees, or volunteers that object to participate
in medical services or procedures conflicting with their personal,
moral or religious convictions. According to an HHS impact analysis,
the rule has the potential to affect more than 570,000 health care
entities [see Washington
Highlights,
Sept. 12].
The regulation takes effect Jan. 18, 2009, and requires written
certification by Oct. 1, 2009, that recipients and sub-recipients
of HHS funds operate in compliance with three existing federal statutes
prohibiting individuals in the health care field from participating
in actions they find religiously or morally objectionable (42 USC
300a-7, section 245 of the Public Health Service Act, and the Weldon
Amendment to the FY 2008 Consolidated Appropriations Act). Complaints
of discrimination addressed by the regulation will be referred to
the HHS Office for Civil Rights.
The AAMC strongly opposed the proposed rule and submitted a Sept.
23 comment letter
noting that there must be a "careful balance between the rights
of the health care professional to avoid behavior that violates
his/her moral code, and the right of the patient to receive legal
health care services that are medically appropriate." The letter
also points out that there exist times when the rights of the patient,
who is in the more vulnerable position, must be given precedence.
Information:
Will Dardani, Constituent Services Specialist
AAMC Health Care Affairs
wdardani@aamc.org
(202) 828-0541
Ivy Baer, Director & Regulatory Counsel
AAMC Health Care Affairs
ibaer@aamc.org
(202) 828-0490
CBO Releases Two Health Care Studies
The Congressional Budget Office (CBO) Dec. 18 released two key
studies focusing on health care issues. The first
document titled, "Key Issues in Analyzing Major Health Insurance
Proposals," focuses on large-scale proposals, provides extensive
background information, and explains CBO's analysis of numerous
issues in the health insurance system. It does not provide analyses
of specific proposals; rather, it provides an overview of CBO's
approach to major questions and issues. The second
document titled, "Budget Options, Volume 1: Health Care,"
includes specific issues related to the financing and delivery of
health care.
Both of these reports provide a foundation for the CBO's work in
the next Congress. According to CBO Acting Director Robert A. Sunshine,
"CBO will continue its own energetic research efforts and will
follow carefully the research of other on health care issues."
Information:
Travis W. Crytzer, Legislative Analyst
AAMC Health Care Affairs/Government Relations
tcrytzer@aamc.org
(202) 828-0418
Nuclear Regulatory Staff Support Options for Cesium
Chloride
The Nuclear Regulatory Commission (NRC) Dec. 12 released a memorandum
on the use of Cesium-137 Chloride, commonly used as a radiation
source in medical and research applications. The memo, "Strategy
for the Security and Use of Cesium-137 Chloride Sources," reports
conclusions by NRC staff that use of cesium chloride ought to be
continued, with greater emphasis on improving security of these
sources rather than banning or phasing out their use. The NRC release
notes that the commission itself has not yet voted on the staff
recommendations.
The staff recommendations largely agree with views expressed by
many medical and scientific organizations, including the AAMC [see
Washington
Highlights, Oct.
10], that underscored the benefits of these sources and the
difficulty of replacing them. The organizations argued that for
many research uses, no effective alternatives currently exist. Security
improvements recommended by the staff include improvements in the
built-in security of the irradiators at time of manufacture, better
articulation of current security requirements, and active development
of alternative forms of cesium sources that would be less dispersible
in event of release.
Information:
Stephen Heinig, Lead Science Policy Analyst
AAMC Biomedical Health Sciences Research
sheinig@aamc.org
(202) 828-0488
IOM Issues Recommendations for Improving HHS,
Health Care Workforce
The Institutes of Medicine (IOM) Dec. 12 released a series of recommendations
for "improving the organization and operations" of the
Department of Health and Human Services (HHS). The recommendations
were part of a broad IOM assessment of HHS, as requested by the
House Committee on Oversight and Government Reform.
Directed at Congress, the recommendations urge action to achieve
greater departmental adaptability and accountability, a more efficient
health care system, and a stronger health care workforce. For example,
the report recommends:
- Longer terms for the directors of the National Institutes of
Health and Centers for Disease Control and Prevention;
- An appointment process for senior-level officials that "protects
the scientific and administrative integrity of major departmental
units";
- Establishing "a capability for assessing" the clinical
and cost effectiveness of medical interventions and procedures;
- Assuring that reimbursement policies are outcomes-based;
- Innovative programs and benefits" to encourage "talented"
and "experienced" individuals to transition between
government and private sector service;
- New programs that "invest in the future generation of biomedical
and health services researchers"; and
- A "new compact" between Congress and HHS that allows
the department greater flexibility yet requires greater accountability.
The report addresses HHS's role in bolstering the health care workforce
in chapter 5, noting the drastic decline in funding for Title VII
health professions programs and that "HRSA's workforce training
programs may at present be an undervalued asset." Recommendations
include:
- Directing HHS to "develop a comprehensive national strategy
to assess and address current and projected gaps in the number,
professional mix, geographical distribution, and diversity"
of the health care workforce; and
- Directing HHS to "evaluate existing health care professional
training programs, continued education programs, and graduate
medical education funding and encourage Congress to invest in
programs with proven effectiveness."
Information:
Christiane Mitchell, Senior Legislative Analyst
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
HHS Describes New HIT Privacy Principles
The Department of Health and Human Services (HHS) Dec. 15 unveiled
a new "toolkit"
designed to help ensure that consumer health information remains
safeguarded as health information technology becomes more prevalent.
Identifying eight privacy principles, HHS Secretary Mike Leavitt
noted the need for "finding the balance between increased access
to information and privacy" and predicted that "over time,
consumer confidence in the handling of health information is likely
to grow just as consumer confidence in online banking has grown,"
provided the appropriate privacy protections are in place.
The guidelines recommend:
- Individual access to personal health information in a readable
form and format;
- A timely means for consumers to dispute and correct erroneous
personal health information;
- Information about the policies and practices related to the
collection, use and disclosure of personal health information;
- Individual choice about with whom, when, and how personal health
information is shared;
- Limitations on the collection, use and disclosure of personal
health information (however, the guidelines specify that with
the proper precautions, collecting and analyzing health care data
should be encouraged as a public good);
- Reasonable assurances that those who hold records maintain data
integrity, even in situations when the Health Insurance Portability
and Accountability Act (HIPAA) Privacy Rule does not apply;
- Reasonable administrative, technical, and physical safeguards;
and,
- Accountability for those who put consumers' personal health
information at risk.
The HHS Office of Civil Rights (OCR) also published new HIPAA Privacy
Rule guidance documents
as part of the toolkit. The OCR guidance seeks to describe "how
the Privacy Rule can facilitate the electronic exchange of health
information."
Information:
Tannaz Rasouli, Senior Legislative Analyst
AAMC Government Relations
trasouli@aamc.org
(202) 828-0525
President-elect Announces Arne Duncan as Secretary
of Education
President-elect Barack Obama Dec. 16 announced
Arne Duncan as his choice for Secretary of Education. Duncan is
the Chief Executive Officer of the Chicago Public Schools and currently
serves on the Board of Overseers at Harvard University, his alma
mater. At the announcement, Secretary-designate Duncan said in his
remarks, "Whether it's fighting poverty, strengthening the
economy or promoting opportunity, education is the common thread."
On the Hill
President-elect Barack Obama nominated three current Members of
Congress to his Cabinet this week. The President-elect Dec. 17 announced
Senator Ken Salazar (D-Colo.) as his choice for Secretary of the
Interior. Colorado Governor Bill Ritter (D) will name a successor
to fill Senator Salazar's seat through 2010. Senator Salazar currently
serves on the Senate Finance Health Subcommittee, as well as the
Senate Agriculture; Nutrition and Forestry; Energy and Natural Resources;
Select Ethics; and, Special Aging Committees.
President-elect Obama Dec. 19 named Rep. Hilda Solis (D-Calif.)
to lead the Department of Labor. Once she vacates her seat, Governor
Arnold Schwarzenegger (R-Calif.) will have 14 days to call a special
election. Rep. Solis serves on the House Energy and Commerce Health
Subcommittee, the Natural Resources Committee, and the Select Committee
on Energy Independence and Global Warming. She also chairs the Congressional
Hispanic Caucus' Task Force on Health and the Environment.
Also on Dec. 19, the President-elect nominated Rep. Ray LaHood
(R-Ill.) as Secretary of Transportation. Rep. LaHood is retiring
from Congress this year after 14 years in the House.
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