Miscellaneous
House Committee Approves FDA Regulation of TobaccoThe House Committee on Energy and Commerce approved the “Family Smoking Prevention and Tobacco Control Act” (H.R. 1108) on April 2. The legislation would: require the FDA to regulate certain tobacco products; prohibit the FDA from banning tobacco products and requiring the reduction of nicotine to zero; ban the use of certain flavors that are attractive to children; and give the FDA authority over advertising and labeling of tobacco products, among other things. The Senate Health, Education, Labor and Pensions Committee (HELP) approved legislation (S. 625) similar to H.R. 1108 in 2007. The legislation now awaits consideration by both the full House and Senate. CMS Issues Proposed Rule on Patient Safety
CMS published a proposed rule to implement the “Patient Safety and Quality Improvement Act of 2005” (Pub. L. 109-41) on February 12. The Act establishes the use of Patient Safety Organizations (PSOs) for the purpose of reporting and analyzing patient safety data to improve the quality of health care. Under the proposed rule, the Agency for Healthcare Research and Quality (AHRQ) will implement the process for certification and listing of PSOs. The proposed rule also establishes confidentiality requirements and outlines the instances where disclosures are permitted, among other things. Economic Stimulus Package Signed in to Law
The “Economic Stimulus Act of 2008” (H.R. 5140)(Pub. Law 110-185) was signed into law on February 13. Under the Act, individuals earning less than $75,000 and couples earning less than $150,000 adjusted gross income that paid income taxes during 2007 could be eligible to receive checks of $600 and $1,200, respectively. Eligibility for the program is phased out with payments terminating for individuals earning more than $87,000 and couples earning more than $174,000 in adjusted gross income for 2007. Individuals and couples could also receive an additional $300 per independent child under 17 years of age.
In addition to checks for individuals and couples, the Act provides for business tax breaks. Specifically, the Act allows companies to write off an additional 50 percent of new investment expenditures in 2008 for items subject to depreciation over 20 years or less under current law. Small businesses (companies with overall investments of less than $800,000 in 2008) would be able to write off the entire cost of new investment expenditures up to $250,000. For additional information on the provisions contained in the “Economic Stimulus Act of 2008,” you are encouraged to speak with your tax professional.
President’s 2009 Budget Proposal Seeks Medicare and Medicaid Cuts
The President released his fiscal year 2009 budget proposal on February 4. The proposal would provide $3.1 trillion in government spending. Included in the proposal is a reduction of $200.9 billion in Medicare and Medicaid spending over five years. The proposal would reduce funding by $183 billion and $18 billion, respectively. According to the Administration, the budget would decrease Medicare’s annual growth rate from 7.2 percent to 5 percent and is necessary to maintain the long-term viability of the program. In addition, the President proposed holding spending for the National Institutes of Health (NIH) flat at the 2008 levels of $29.3 billion. Spending for the Centers for Disease Control (CDC) would be cut by $433 million. Funding under Title VII of the Public Health Service Act would be reduced by $240 million. The Food and Drug Administration (FDA) would see a 5.7 percent increase ($130 million) over 2008 levels. Democratic leadership in the U.S. House of Representatives and the U.S. Senate do not appear to support many of the President’s recommended reductions to the nation’s federally funded health care programs. As the budget process continues, the ACOI will carefully monitor budgetary proposals that impact physicians, patients and the overall health care delivery system.
State of the Union Address Touches on Health Care
The President presented to a joint session of Congress his seventh and final State of the Union Address on January 28. A large part of the speech focused on the state of the economy and the war on terror. However, in addition to education, entitlement spending and energy, the President also addressed the state of health care in the nation. Specifically, the President called on Congress to take the following actions: reform the tax code to provide standard deductions for every American who purchases health insurance; expand the availability of Health Savings Accounts (HSAs) and allow for the formation of Association Health Plans (AHPs); continue efforts to improve the adoption of health information technology (HIT); promote the sharing of information by federal agencies to promote greater efficiency and quality within the health care delivery system; and, reform the medical liability system to prevent costly and frivolous lawsuits. The President did not address physician reimbursement under federal health programs such as Medicare and Medicaid. You can read the full text of the speech at www.whitehouse.gov/stateoftheunion/2008/index.html.
Omnibus Appropriations Legislation Approved
The “Consolidated Appropriations Act, 2008” (Pub. L. No. 110-161) was signed into law on December 26, 2007. The Act funds numerous parts of the Federal Government through September 30, 2008. It is expected, however, that supplemental funding legislation will be considered later this year. The Act provides $65.6 billion for the U.S. Department of Health and Human Services (DHHS), $29.2 billion for the National Institutes of Health (NIH) and $1.7 billion for the Food and Drug Administration. In addition, the law provides $287 million for rural healthcare and $2.1 billion for community health centers to provide access to dental and medical services. The legislation also allows for the importation of a 90-day supply of prescription drugs from Canada for personal use, among other things. This provision does not allow for the importation of controlled substances or biologics. The all-encompassing package, which consists of 11 separate appropriation bills, was put together to overcome presidential vetoes, threats thereof and a dwindling calendar on which to advance legislation. The appropriations process for 2009 will begin in earnest as Congress returns from its winter break.
Congratulations to the Health Policy Fellowship Class of 2006 – 2007
The Health Policy Fellowship Class of 2006 - 2007 was honored in Washington, DC at the American Osteopathic Association’s Bureau on Federal Health Programs meeting on September 7, 2007. The year-long program is designed for individuals who are preparing for leadership roles in the osteopathic profession and positions of influence in health policy. Included in the Class of 2006 – 2007 were osteopathic internists Joseph A. Giaimo, DO, Roy Harris, DO, Robert Hasty, DO and Anthony Ognjan, DO. Each physician completed an extensive research project on significant health policy issues including health information technology, health savings accounts, obesity and patient safety, respectively. These internists join a list of distinguished alumni who have completed the intensive Health Policy Fellowship program. Congratulations on your accomplishments!
Number of Uninsured Americans Increases
According to data recently released by the U.S. Census Bureau, the number of uninsured Americans rose from 44.8 million in 2005 to 47 million in 2006. Children under the age of 18 accounted for 8.7 million uninsured Americans. Texas had the highest rate of individuals lacking insurance coverage at 24.1 percent while Minnesota had the lowest amount of uninsured persons at 8.5 percent. Of the 249.8 million Americans with health insurance in 2006, 59.7 percent were covered for some or all of the year through their employment. These and other statistics are certain to play a role in future health policy debates. You can access this and other statistical information at www.census.gov.
Acting CMS Administrator Named
The White House appointed Kerry N. Weems Acting Director for the Centers for Medicare and Medicaid Services on September 4. Mr. Weems was first nominated by the President to head CMS in early May. While the U.S. Senate Finance Committee conducted a hearing on July 25, the nomination is still pending. A 24-year veteran of the Department of Health and Human Services, Mr. Weems has said that he will push for tougher oversight and an increase in transparency. Additional action on his confirmation has not been scheduled.
Senate Committee Approves Legislation Allowing FDA Oversight of Tobacco Products
The U.S. Senate Health, Education, Labor and Pensions (HELP) Committee reported favorably the “Family Smoking Prevention and Tobacco Control Act” (S. 625) by a vote of 13-8 on August 1. The legislation gives the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products. The legislation would be funded by an approximate 2.5 percent per-pack tax on cigarettes. The legislation is expected to be considered by the full Senate following the August recess. Similar legislation has been introduced in the U.S. House of Representatives where action currently is not scheduled.
Senate Committee Conducts Hearing on Gifts from Pharmaceutical Industry
The U.S. Senate Special Committee on Aging, Chaired by Herb Kohl (D-WI), conducted a hearing entitled, “Paid to Prescribe?: Exploring the Relationship Between Doctors and the Drug Industry,” on June 27. The Committee heard testimony from physicians, a state legislator and a representative from the pharmaceutical industry examining the impact of pharmaceutical marketing on physicians prescribing activities and the resulting patient care.
A few of the physician witnesses presented testimony stating that the large amount of resources spent by pharmaceutical companies on marketing to physicians and on funding various educational activities creates conflicts of interest and ultimately compromises patient care and the quality and independence of scientific research. Other witnesses, including Marjorie Powell, Esq., Senior Assistant General Counsel for the Pharmaceutical Research and Manufactures of America (PhRMA), stated that education of the physician community is important to promote quality health care. Further, Ms. Powell testified that measures are in place to protect the integrity of research and the independence of practicing physicians.
Chairman Kohl concluded the hearing by expressing his desire to work in conjunction with Charles E. Grassley (R-IA), Ranking Member of the Senate Committee on Finance, to pursue a national registry of pharmaceutical gifts to physicians. The ACOI will continue to monitor this and similar legislation.
Cardiologist Tapped to become Nation’s 18th Surgeon General
President Bush nominated cardiologist James W. Holsinger, M.D., Ph.D., to become the nation’s 18th surgeon general on Thursday, May 24. According to a statement released by President Bush, “As America’s chief health educator, [Holsinger] will be charged with providing the best scientific information available on how Americans can make smart choices that improve their health and reduce their risk of illness and injury.” It is expected that Dr. Holsinger will focus on efforts to combat childhood obesity. Dr. Holsinger’s nomination awaits confirmation by the U.S. Senate.
President Releases Proposed Budget for FY 2007
The President released his $2.77 trillion federal budget proposal for fiscal year 2007 on February 6. The budget proposes cutting non-defense discretionary spending and controlling the growth of mandatory spending. The Department of Health and Human Services (HHS) has been appropriated $676.9 billion for fiscal year 2006. The President proposes funding HHS at $697.7 billion for fiscal year 2007. This increase is a result of a three percent growth in mandatory spending and a four percent reduction in discretionary spending. The budget also proposes controlling the cost of entitlement programs such as Medicare and Social Security. To this end, the budget would reduce Medicare spending by $35.9 billion over five years. Savings under the Medicare program would be achieved through, but is not limited to, the reduction of payments to hospitals, nursing homes and other Medicare providers. Congress is expected to face an uphill battle in efforts to obtain the President’s proposed spending levels in this, an election year. The ACOI will continue to monitor this throughout the year.
MedPAC Appointments Announced
The Comptroller General of the United States, General David M. Walker, appointed four new members to the Medicare Payment Advisory Commission (MedPAC) on May 5, 2006. The new Commission members, whose terms will expire in 2009, are Mitra Behroozi, J.D., executive director, 1199SEIU Benefit and Pension Funds; Karen R. Borman, M.D., professor of surgery and vice-chair for surgical education, University of Mississippi Medical Center; Ronald D. Castellanos, M.D., physician, Southwest Florida Urological Associates; and, Douglass Holtz-Eakin, Ph.D., director, Maurice R. Greenberg Center for Geoeconomic Studies and Paul A. Volcker Chair in International Economics Council on Foreign relations. Additional Commission terms expire in 2007 and 2008.
American Osteopathic Association Trustee Ray E. Stowers, DO served on MedPAC for six years ending in April 2006. Dr. Stowers is to be commended for his service and outstanding representation of the osteopathic profession. Efforts are underway to secure the appointment of additional osteopathic physicians to this federal advisory panel.
Support Medical Education in Afghanistan
The US military 14th Combat Support Hospital in Afghanistan is seeking donations of medical text books to train local family practice residents in critical care. Reports from the front indicate that some of the text books in use date to the 1950’s. The Combat Support Hospital is in need of gently used, more up-to-date medical text books of all types to support the training of residents. If you are interested in donating texts, they may be sent to Deputy Commander for Clinical Services, Colonel W. Thomas Frank at 14th CSH, TF Med (DCCS), Medical Text Book Project, APO-AE 09354.
Executive Order Issued to Advance Quality and Efficiency Of Federal Health Programs
President Bush signed an Executive Order “Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs” on August 22, 2006. The Order was issued to “ensure that health care programs administered or sponsored by the Federal government promote quality and efficient delivery of health care through the use of health information technology, transparency regarding health care quality and price, and better incentives for program beneficiaries, enrollees, and providers.” Programs subject to the Order include the Federal Employees Health Benefit Program (FEHBP), the Medicare Program, programs operated by the Indian Health Service, and TRICARE. It does not apply to Medicaid or the State Children’s Health Insurance Program (SCHIP). The Executive Order directs Federal agencies to utilize, where available, health information technology (HIT) that meets recognized interoperability standards; implement programs measuring the quality of health care services based upon standards established by multi-stakeholders (Transparency of Quality Measurements); make available pricing information and participate in the development of information regarding the overall costs of services for common episodes of care and the treatment of common chronic diseases (Transparency of Pricing Information); and develop and identify approaches that encourage and facilitate the provision and receipt of high-quality and efficient health care. Federal agencies are further directed to comply with the provisions of the Executive Order by January 1, 2007.
Interested in Serving on Federal Advisory Panels, Commissions and Committees?
The ACOI is working with the American Osteopathic Association to identify and advance qualified internists and subspecialists to appointments on federal advisory panels, commissions and committees. As the ACOI continues its efforts to advance osteopathic internal medicine in Washington, DC, these appointments provide the opportunity for physicians to have an impact on the federal rules and regulations which affect the provision of health care services. Further, such appointments are essential in ensuring that the voices of osteopathic physicians are heard and considered in the development of federal health policy. If you are interested in serving in this capacity, please forward a copy of your curriculum vitae to Tim McNichol at tmcnichol@acoi.org.
110th Congress by the Numbers
The 110th Congress convened at 12 Noon on January 4, 2007. The U.S. Senate is comprised of 49 Democrats, 49 Republicans and two Independents. The two Independents will caucus with the Democrats providing them with control of the Senate. The U.S. House of Representatives is comprised of 237 Democrats and 203 Republicans. A record 90 woman now serve in the House and Senate. In the two chambers there are a combined 11 physicians, three dentists, three nurses, two veterinarians, one psychologist, one optometrist and one pharmacist. There are 216 members and senators involved in law for their profession.
ACOI President Works to Shape AOA Legislative and Regulatory Agenda
ACOI President Joanna R. Pease, DO, FACOI attended the American Osteopathic Association’s (AOA) Bureau on Federal Health Program (BOFHP) meeting in Washington, DC on January 19. Attendees at the meeting heard a congressional panel discuss the impact of the November, 2006 elections and the outlook for health care legislation over the next two years. In addition, AOA staff presented a summary of legislative and regulatory activity. The meeting concluded with a review of the AOA’s Agenda for the 110th Congress, which Dr. Pease and the ACOI Committee on Government Affairs played an integral role in shaping. Robert S. Juhasz, DO, FACOI is the Chair of the Committee on Government Affairs and also serves on the BOFHP.
Prior to the meeting, Dr. Pease wrote to Marcelino Oliva, D.O., Chairman of the AOA BOFHP, recommending legislative and regulatory priorities for the AOA and the osteopathic profession as a whole for the next two years. Cognizant of the altered majorities in the House and Senate, ACOI suggested that the Agenda must be shaped with consideration of the policy priorities of the new leadership. The Bureau accepted many of the recommendations put forth by the College, which included suggestions related to physician payment under the Medicare Program, medical liability insurance reform and graduate medical education, among other things. For additional information on the advocacy efforts of the ACOI you may contact Tim McNichol at tmcnichol@acoi.org or by calling toll-free 1-800-327-5183.
President Delivers State of the Union Address
President George W. Bush delivered his seventh State of the Union Address on January 23. The President outlined his vision for the future and put forth domestic and foreign policy recommendations in the areas of health care, energy, education, immigration and the war on terror, among other issues.
In the area of health care, the President announced proposals to make basic, private health insurance more available and affordable for Americans and to move health care coverage away from government run programs to private insurers. To accomplish these goals, the President outlined a proposal to create a standard tax deduction for individuals or families of $7,500 or $15,000 respectively for purchasing health insurance. Under his proposal, the tax deductions would be applicable regardless of the type or source of the insurance coverage. Further, the deduction amounts would be adjusted by the Consumer Price Index (CPI) each year. Employer-sponsored health care would loose its tax-exempt status and become taxable income.
In addition, the President announced his Affordable Choices Initiative. The initiative is designed to assist states in their efforts to make available private health insurance for low-income uninsured and hard-to-insure individuals and families. According to the White House, the initiative will allocate current Federal health care funding more effectively without creating new entitlements or additional Federal spending. State participation would be voluntary and subject to approval by the Secretary of Health and Human Services (HHS).
Further, the President highlighted continued interest in efforts to increase transparency of the health care system; to improve the adoption of health information technology; to expand the use and availability of Health Savings Accounts (HSAs); to promote the formation of Association Health Plans (AHPs); to permit the purchase of health insurance across state lines; to promote the adoption of medical liability reforms to limit costly and frivolous lawsuits; and, to promote prevention, wellness and fitness.
U.S. House of Representatives and U.S. Senate Approve Budget Blueprint
Both the U.S. House of Representatives and the U.S. Senate recently approved budget resolutions for Fiscal Year 2008, H.R.Con.Res 99 and S.Con.Res 21 respectively, that set federal spending at nearly $3 trillion. Members of the House and Senate must now reconcile the competing budget resolutions and arrive at a concurrent budget resolution. The approved concurrent resolution will not have the effect of law or be subject to a presidential veto. It will, however, set revenue and spending targets for the federal government and will serve as the foundation for tax and spending legislation that, when enacted, will have the force of law. Congress has failed to approve a concurrent budget resolution for three of the last five years. The ACOI will continue to monitor closely the budgetary process as it goes forward. For additional information you may contact Tim McNichol at tmcnichol@acoi.org or by calling toll-free 1-800-327-5183.
Centers for Medicare and Medicaid Services Administrator Nominated
President George W. Bush announced the nomination of Kerry N. Weems as Administrator of the Centers for Medicare and Medicaid Services (CMS). Mr. Weems, who currently serves as the Department of Health and Human Services (HHS) Deputy Chief of Staff, has worked at HHS for 24 years. The U.S. Senate must confirm the nomination and is not expected to do so for several months. As CMS Administrator, Kerry Weems would be responsible for overseeing the Medicare and Medicaid programs which account for a large part of the nation’s health care spending. CMS is currently under the direction of Acting Administrator Leslie V. Norwalk, Esq. who took the reins following the resignation of Mark McClellan, MD in October 2006.
Agency for Healthcare Research and Quality asked to Examine Medical Errors
U.S. House of Representatives Committee on Energy and Commerce Chairman John Dingell (D-MI), Ranking Member Joe Barton (R-TX) and others sent a letter to the Agency for Healthcare Research and Quality (AHRQ) requesting an investigation into preventable medical errors. The Committee requested that the AHRQ consider pursuing the continued study of medical errors associated with physicians and resident work hours through the Institute of Medicine (IOM).
According to the letter sent to the AHRQ, the Committee became interested in the matter following an AHRQ-funded study published by the Public Library of Science entitled, “The Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attention Failures.” The study seemed to support previous concerns that medical residents and interns may cause avoidable adverse events as a result of sleep deprivation and being overworked. The ACOI will continue to monitor this and other activities by Congress and administrative agencies that would impact the training of interns and residents as well as the practice of medicine.