2015

Congress and the Administration Strike Budget Deal (November 2015)
Congressional leaders and the Administration agreed on a budget package that prevented a shutdown of the Federal government.  Absent the bipartisan agreement that raised the federal debt ceiling through March 2017, the government was faced with defaulting on its debt obligations and a shuttering of its operations.  The measure is estimated to cost $80 billion.  One unfortunate provision of the agreement is a continuation of the reduction by two percent of Medicare payments under sequestration guidelines.  Signed into law by the President, the act repeals the provision of the Affordable Care Act requiring employers with more than 200 employees to automatically enroll new full-time workers into an employee’s health plan.  Congress must still act to approve appropriations legislation before the end of the year.
 
Two-Midnight Rule Finalized (November 2015)
CMS recently released a final rule adopting changes to the controversial “Two-Midnight” rule.  Under the finalized rule, inpatient admissions are payable under Medicare Part A if the admitting physician believes the patient will require a hospital stay that will span two midnights and the medical record supports that expectation. The greater flexibility made available under the final rule permits a case-by-case analysis to determine if a shorter stay should be paid under Medicare Part A.  According to the rule, “The physician’s decision should be based on such complex medical factors as patient history and comorbidities, the severity of signs and symptoms, current medical needs and the risk of an adverse event.”  The new rule goes into effect on January 1, 2016.  You can learn more about the final rule by visiting https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-4.html.

ACOI and Others Express Concern with Stage 3 of the Meaningful Use Program (November 2015)
The ACOI and others recently wrote to leadership of the House and Senate regarding the Administration’s decision to move forward with implementation of Stage 3 of the Meaningful Use Program. The groups recently asked Congress to refocus the program to prevent the continuation of requirements that are overly difficult to achieve. As an example of the challenges faced by physicians under the program, only 12 percent of participants were able successfully to participate in Stage 2 of the program. It is ACOI’s hope that Congress will act to prevent the Meaningful Use Program from becoming further complicated almost ensuring failure. The program is an incentive program created in 2009 to promote greater efficiency and improve patient outcomes through the use of electronic health records. Stage 3 is the final stage of the program. You can view this and other correspondence at www.ACOI.org.

FDA Announces Enforcement Action against Tobacco Retailers (November 2015)
The Food and Drug Administration (FDA) announced the filing of the first-ever complaints to initiate no-tobacco-sell orders (NTSOs) against retailers who have repeatedly violated restrictions on the sale and distribution of tobacco products. In order for the FDA to take such action, the law requires retailers to have had five or more repeat violations during compliance inspections within 36 months. According to the FDA, more than 2,600 youth under the age of 18 smoke their first cigarette each day. Nearly 600 of them will become daily smokers. It is estimated that 4.6 million middle and high school students used a tobacco product in 2014. The FDA is working to combat youth tobacco use through its compliance and enforcement efforts. According to a release by the FDA, as of October 1, 2015 the FDA has conducted more than 508,000 inspections of tobacco product retail establishments, issued more than 35,700 warning letters to retailers for violating the law and initiated more than 5,200 civil money penalty cases.

$2.2 billion Awarded under Ryan White HIV/AIDS Program (November 2015)
The Department of Health and Human Services (HHS) announced $2.2 billion in funds were awarded under the Ryan White HIV/AIDS Program in fiscal year 2015. The funds were provided to cities, states and local community-based organizations. According to HHS, “More than half a million people living with and affected by HIV in the United States continue to have access to critical HIV healthcare, support services, and essential medications,” as a result of funding provided under this program. The funding has been instrumental in improving clinical and public health outcomes by preserving health, extending life expectancy and reducing HIV transmissions. It is estimated that the program provides services to nearly 536,000 people each year. You can learn more about the Ryan White HIV/AIDS Program at http://hab.hrsa.gov/abouthab/aboutprogram.html.  

HHS Awards Funds to Expand Primary Care Workforce (October 2015)
The Department of Health and Human Services (HHS) announced the award of more than $240 million to expand the primary care workforce under the National Health Service Corps (NHSC) and NURSE Corps scholarship and loan repayment programs.  The funds will provide: new awards to students pursuing primary care training leading to a degree in medicine, dentistry or a degree as a nurse-midwife, physician assistant, or nurse practitioner; new awards under the NHSC Student-to-Service Loan Repayment Program for medical students in the last year of school; and new awards to educators to serve as faculty and eligible health profession schools, among other things. Additional information is available at www.NHSC.hrsa.gov. 

White House Announces Efforts to Address Prescription Drug Abuse and Heroin (October 2015)
The ACOI and nearly 40 other provider groups support efforts announced by the White House to stem prescription drug abuse and heroin use.  President Obama traveled to West Virginia to hear firsthand about the toll drug abuse and heroin use is taking on Americans and their families, while straining law enforcement and treatment programs.  During his visit to West Virginia, the President announced federal, state, local and private sector efforts aimed at addressing the prescription drug abuse and heroin epidemic.  As part of the effort, the ACOI and others will work to train more than 540,000 healthcare providers in opioid prescribing over the next two years.  Groups such as CBS, ABC, the New York Times and others will donate millions of dollars in media space for PSAs about the risk of prescription drug misuse.
In addition to the efforts of providers and other organizations to address the drug abuse epidemic, the President issued a memorandum to federal departments and agencies. The memorandum directs federal departments and agencies to provide training on the prescribing of opioids by federal health care professionals who prescribe controlled substances as part of their federal responsibilities. Further, the memorandum directs federal departments and agencies that directly provide, contract to provide, reimburse for, or otherwise facilitate access to health benefits, to identify barriers to medication-assisted treatment for opioid use disorders and develop action plans to address these barriers.

CMS Issues Final Rule Impacting Stages 2 and 3 of the Meaningful Use Program (October 2015)
The Centers for Medicare and Medicaid Services (CMS) recently released a final rule modifying Stage 2 and implementing Stage 3 of the Meaningful Use (MU) Program.  The MU program is an incentive program created in 2009 to promote greater efficiency and improve patient outcomes through the use and adoption of certified electronic health records (EHRs).  The program was designed to be implemented through three stages over five years.  
In an effort to remove some of the perceived barriers to successful reporting, CMS shortened the 2015 (Stage 2 MU) reporting period from a full year to 90 days and reduced the number of objectives required for eligible professionals to successfully participate in the incentive program.  In addition, in response to concerns raised by the ACOI and other physician groups, mandatory participation in Stage 3 will be delayed until 2018 with optional participation in Stage 3 for 2017.  CMS signaled additional changes to the rule may be forthcoming.  The final rule provides an additional 60 days for public comment.  You can learn more about the MU program and provider requirements at www.cms.gov.    
The Office of National Coordinator for Health Information Technology concurrently issued a rule addressing the certification of EHR technology. The ACOI and others continue to express concern with the reporting program and the certification of EHRs.  You can view a copy of these and other comments submitted at http://www.acoi.org/advocacy/legislative-and-regulatory-comments.html.

CBO Report Sees Growth in Medicare and Medicaid Spending  (September 2015)
According to a report released by the non-partisan Congressional Budget Office (CBO), federal spending for all major healthcare programs will increase by $106 billion in 2015.  The largest increase in spending is expected to be seen in the Medicaid program.  Medicaid spending is projected to increase by $49 billion to a total of $350 billion.  The report cites the Affordable Care Act (ACA) as the primary driver of the increase in spending under the Medicaid program because of the resulting expansion of Medicaid recipients.  Medicare spending is projected to increase by $35 billion to a total of $639 billion, the fastest growth in Medicare spending since 2009. The recently-enacted Medicare Access and CHIP Reauthorization Act (MACRA) is expected to result in additional growth in Medicare and Medicaid spending over the next decade.

Cardiologist Nominated to Lead FDA (September 2015)
President Obama nominated cardiologist Robert Califf, MD, to serve as Commissioner of the Food and Drug Administration (FDA).  Dr. Califf is a researcher who joined the FDA in January of this year.  He currently serves as the Deputy Commissioner for Medical Products and Tobacco.  Dr. Califf has held this position since March.   His nomination now goes to the Senate where it is expected to be approved with little dissent. The current acting Commissioner, Dr. Stephen Ostroff, took over following the resignation of Dr. Margaret A. Hamburg who served as Commissioner of the FDA for nearly six years. 

CDC Report Shows Drop in Uninsured Rate (August 2015)
According to a report released by the Centers for Disease Control (CDC), the percentage of uninsured adults (18 to 64 years of age) dropped from 20.4 percent in 2013 to 16.3 percent in 2014. The report goes on to find that 36 million Americans of all ages lacked insurance in 2014 (11.5 percent).  Coverage was attained by 5.9 million adults under the age of 65 through health insurance market places established through the ACA.   In addition, the report noted that the percentage of uninsured adults decreased more in states that expanded coverage under the Medicaid program.  Additional information on the report’s findings is available at www.cdc.gov.

House Approves Legislation Advancing Personalized Care (August 2015)
The House recently approved the “21st Century Cures Act.”  This legislation is intended to modernize and personalize healthcare, support research and streamline the healthcare system to deliver better, faster cures to patients.  According to one of the law’s original sponsors, “This bill is about making sure our laws, regulations, and resources keep pace with scientific advances.”  To this end, the legislation includes increased funding for the National Institutes of Health and provisions to advance widespread interoperability among federal agencies to advance the goals of the legislation.  In a statement of administrator policy, the White House signaled support for the bill with the need for continued work with Congress to advance strategies to prevent and cure diseases and expand health.  Similar legislation is being drafted in the Senate.  Action in the Senate is not scheduled at this time.  The ACOI will continue to monitor the progress of this and similar legislation.  The concepts contained in the legislation enjoy significant bi-partisan support increasing the chances that legislation can be sent to the President for enactment.

Home Medical Practice Demonstration Program Extended (August 2015)
The President signed into law legislation extending agreements under the Medicare Independent at Home Medical Practice Demonstration Program for two years.  As a result, practices will be able to participate in the program for a total of five years.  The program is testing a service delivery model designed to reduce costs and enhance the quality of care for patients with multiple chronic conditions.  As recently reported, the program saved over $25 million in its first three years while meeting quality benchmarks. According to CMS, the demonstration program saved an average of $3,070 per Medicare beneficiary while still paying incentive payments to participating practices. The demonstration program was first established under the ACA.  As a result of the early success of this program, it is certain to be closely monitored with the possibility of further expansion to increase Medicare savings and improve patient care for Medicare beneficiaries with multiple chronic conditions.  

Legislation Addressing Observation Status Approved (August 2015)
The Senate recently approved legislation to require notification of observational status. The House had previously approved the legislation.  Under the legislation sent to the President for signature, a hospital or critical access hospital with an agreement with the Secretary of Health and Human Services must give each individual who receives observational services as an outpatient for more than 24 hours an adequate oral and written notification of their status within 36 hours after beginning to receive the services. The notification must explain the patient’s status as an outpatient and the possible implications of the status, among other things.  President Obama is expected to sign this legislation into law.

President Nominates Slavitt as Permanent head of CMS (August 2015)
Acting Administrator for the Centers for Medicare and Medicaid Services (CMS), Andrew Slavitt, has been nominated by President Obama to fill the vacancy created by the resignation of Administrator Marilyn Tavenner in January 2015.  Acting Administrator Slavitt has been with CMS since June 2014.  His nomination now goes before the Senate Finance Committee, where it is expected to be challenged. Senate Finance Committee Chair, Orrin Hatch (R-UT) has raised concerns with regard to Slavitt’s past role as an executive vice president at UnitedHealth Group, Inc.  A confirmation hearing and vote has not been scheduled to date.

ACOI Member Named to Michigan Prescription Drug and Opioid Abuse Task Force (July 2015)
ACOI member Stephen Bell, DO, FACOI, has been appointed by Michigan Governor Rick Snyder to the newly-formed Michigan Prescription Drug and Opioid Abuse Task Force.  The Task Force was created to examine recent trends, evaluate strategic options and develop a statewide action plan.  Dr. Bell joins the Lieutenant Governor, State Attorney General, Director of the Department of Health and Human Services and other stakeholders on this important bi-partisan Task Force.  The recommendations of the Task Force are expected to be released later this year.  

House Approves Repeal of IPAB (July 2015)
The House approved legislation to repeal the provision of the Affordable Care Act establishing the Independent Payment Advisory Board (IPAB).  The IPAB was created under the ACA to develop proposals to reduce the per-capita rate of growth in Medicare spending.  While this section of the ACA has been subject to bi-partisan criticisms, as well as concerns raised by the physician community, the White House recently indicated that the President will veto the legislation if it presented to him for his signature.  The bill approved by the House has been referred to the Senate Finance Committee where no action has been scheduled.  The ACOI will continue to monitor this matter closely.
 
Medicare At-Home Care Demonstration for Chronically Ill Shows Promise (July 2015)
According to CMS, a new demonstration program allowing Medicare beneficiaries with chronic conditions to receive comprehensive primary care services at home saved over $25 million while meeting quality benchmarks. The three-year Independence at Home Demonstration Program was created under the ACA and includes 17 participating practices.  Nine of the practices will receive incentive payments totaling $11.7 million for reducing Medicare costs while meeting quality goals.  According to CMS, the demonstration program also saved an average of $3,070 per Medicare beneficiary.  As a result of the early success of this program, it is likely to gain additional attention in the future as a means to improve care while reducing costs under the Medicare program.  

New Medicare Program Aims to Cut Cardiovascular Disease (July 2015)
The Centers for Medicare and Medicaid Services (CMS) unveiled the Million Hearts Cardiovascular Disease Risk Reduction payment model, which will allow participating healthcare providers to work with high-risk Medicare beneficiaries in an effort to reduce the absolute risk for heart disease or stroke. The payment model, created under the ACA, will operate for five years and aims to enroll over 300,000 Medicare beneficiaries and 720 practices varying in size and patient mix. Under the model, healthcare providers will work with each patient to develop a personalized risk modification plan targeting specific risk factors. Providers will be paid for reducing the patients’ risks.  Applications will be accepted through September 4. Additional information is available at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-05-28.html.

House Committee Approves Legislation Advancing Personalized Care  (July 2015)
The House Energy and Commerce Committee unanimously approved the “21st Century Cures Act.”  This legislation is intended to modernize and personalize healthcare, support research and streamline the healthcare system to deliver better faster cures to patients. While the legislation enjoys significant bi-partisan support, action by the full House has yet to occur. House leadership indicated that action is possible when it returns from recess.  Similar legislation has not been considered in the Senate.  

House Approves Legislation to Address Prescription Drug Abuse (May 2015)
The House recently approved legislation to prevent prescription drug abuse and diversion. The bill approved by the House is intended to promote collaboration between the Drug Enforcement Agency (DEA), drug distributors and pharmacies. In addition, the bill would direct collaboration between the Department of Health and Human Services (HHS), the Office of National Drug Policy and the DEA to work together to improve access to medically-necessary medications and enforcement. The bill also directs the Secretary of HHS to submit a report identifying: (1) obstacles to legitimate patient access to controlled substances; (2) issues with diversion of controlled substances; and (3) how collaboration between federal, state, local, and tribal law enforcement agencies and the pharmaceutical industry can benefit patients and prevent diversion and abuse of controlled substances. Similar legislation has been introduced in the Senate where no additional action has been taken to date.  It is not clear if or when the Senate will act on this or similar legislation.

ONC Issues Updated Health IT Privacy and Security Guidance (May 2015)
The Office of National Coordinator for Health Information Technology (ONC) released an updated publication entitled, “Guide to Privacy and Security of Electronic Health Information.” The intent of the Guide is to help health care providers better understand how to integrate federal health information privacy and security requirements into their practices. The Guide provides updated information about compliance with the Medicare and Medicaid Electronic Health Record Incentive Program’s privacy and security requirements as well as the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Breach Notification Rules.  You can learn more or download a copy of the Guide at www.healthit.gov.

Congress Adopts Budget Blueprint (May 2015)
The House and Senate approved a non-binding joint budget resolution that provides the framework for appropriations legislation that will fund the government for fiscal year 2016.  Included in the package is language instructing committees of jurisdiction in both the House and Senate to explore a full repeal of the Affordable Care Act (ACA) through budget reconciliation – a budget rule designed to force committees to change mandatory and entitlement spending to create savings. The joint resolution also directs committees with jurisdiction to determine the “specific Medicare reforms needed to bring spending levels under current law in line with the budget.” The budget deal also requires full payment of the recently-enacted Medicare physician payment reform legislation. As approved, the cost of the legislation is only partially offset.  While the budget resolution is non-binding, it will serve as a blueprint for the budget negotiations that are just getting underway and will run through at least the fall. The ACOI will continue to closely monitor budget initiatives that could impact physicians and the patients they serve.

House and Senate Adopt Budget Blueprints (April 2015)
Prior to taking a two-week recess, the House and Senate adopted non-binding budgets for fiscal year 2016.  The approved resolutions serve as the blueprints for appropriations legislation that will be considered by Congress later this year to fund the operations of the federal government.  Of note, the budgets would reduce federal spending by more than $5 trillion over 10 years.  In addition, both House and Senate packages would fully repeal the Affordable Care Act (ACA) for an assumed savings of approximately $2 trillion dollars.  This assumption raises some budgetary questions in light of the fact that there have been more than 50 votes in the House to-date to repeal the ACA to no avail.  Further, the constitutionality of the ACA has been upheld by the US Supreme Court making it more difficult to do away with the law in its entirety.  Finally, both the Senate and House resolutions would find savings from the Medicare program of $431 billion and $148 billion, respectively.  Approval of these two resolutions marks the beginning of the budget process that will be played out over the next several months.
  
HHS Announces Increased Health Insurance Coverage as a Result of the ACA
According to a report released by the Department of Health and Human Services, about 16.4 million uninsured individuals gained coverage through the ACA.  Approximately 14.1 million adults gained coverage since the first open enrollment period in late 2013.  An additional 2.3 million young adults remained on a parent’s plan under a provision of the ACA that extends coverage to the age of 26 for children.  According to the HHS report, the uninsured rate dropped 7.1 percent to 13.2 percent.
 

CMS Announces Coverage for Lung Cancer Screening (February 2015)
The Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination (NCD) for Medicare coverage of screening for lung cancer with low dose computer tomography (LDCT) if certain eligibility requirements are met, effective February 5.  The Decision Memo (CAG-00439N) lists the specific eligibility criteria for beneficiaries, reading radiologists and radiology imaging facilities.  Generally, a Medicare beneficiary is eligible for the preventive service benefit if they meet the following criteria:  55-77 years of age; asymptomatic; tobacco smoking habit of at least 30 pack years; current smoker or one who has quit smoking in the last 15 years; and receives a written order for LDCT lung cancer screening that meets the criteria outlined in the memo.  Additional information is available at www.cms.gov.

Omnibus Spending Package Signed into Law (January 2015)
Prior to adjournment at the end of December, the House and Senate approved, and the President signed into law, a $1.01 trillion package to fund most of the government through September 30, 2015.  Included in the package was funding for Labor-Health and Human Services-Education departments.  Of note, the legislation provides $158.2 billion in discretionary spending and $672 billion in spending for existing mandatory programs.  The legislation also rescinded $10 million in funding for the controversial Independent Payment Advisory Board created under the Affordable Care Act (ACA) to rein in spending and increase the solvency of the Medicare program. The bill provides $2.74 billion in emergency funding to help contain Ebola in West African countries.  Finally, the legislation funds the Centers for Disease Control at $6.93 billion and the National Institutes of Health at $30.1 billion, excluding the emergency funding for Ebola.  Unfortunately, Congress failed to take the opportunity to address permanently the Medicare physician payment formula.  As a result, the temporary patch currently in place is set to expire March 31 absent congressional action. 

 

2014

CMS Reports Low Healthcare Spending Growth (December 2014)
According to a report recently released by the Centers for Medicare and Medicaid Services (CMS), healthcare spending continued to grow at a historically low rate in 2013.  The report found that healthcare spending grew by 3.6 percent.  As a result, total healthcare spending reached $2.9 trillion or $9,255 per person.  According to the report, Medicare spending accounted for 20 percent ($585.7 billion) of the total spent on healthcare in the US.  During this same time, Medicare enrollment grew by 1.6 million beneficiaries to a total of 51.3 million enrollees.  Private health insurance premiums grew by 2.8 percent and accounted for 33 percent of the total healthcare spending.  Private health insurance spending reached $961.7 billion and covered 189.3 million people (60 percent of the total population).

 
Final Rule to Combat Fraud is Issued (December 2014)
CMS recently finalized a rule to keep healthcare providers with large Medicare debt from exiting the Medicare program only to return as a new business entity.  In addition, the rule allows for the removal of those with abusive billing practices from the program.  The rule was issued as a result of requirements contained in the Affordable Care Act (ACA).  Finally, the rule allows CMS to deny enrollment of providers who are affiliated with others who have large unpaid Medicare debt.  The rule is a continuation of the government’s effort to reduce fraud within federally-funded programs.

 
Administration Sued by House Republicans (December 2014)
House Republicans filed a lawsuit against the Obama Administration accusing it of overstepping its constitutional powers in its implementation of the ACA.  Specifically, the suit charges that the delayed enforcement of the employer mandate as required by the ACA amounts to rewriting key provisions of the ACA without the necessary congressional action.  The suit further alleges that certain payments to insurers under the ACA are improper.  While the ACA does authorize the payments to insurers, Congress must appropriate the proper funds.  The suit states that absent the appropriations, the payments cannot be made.  Essentially, the suit claims that the Administration has amended the law and acted counter to what was approved by Congress.  The Administration has responded that it has worked within its authority to execute the law.  This novel lawsuit enters uncharted territory.  It is unclear what the next steps will be in this legal process.  The ACOI will continue to follow the matter closely.

HHS Report Shows Fewer Patient Injuries (December 2014)
According to a report recently released by the Department of Health and Human Services, an estimated 50,000 fewer patients died in hospitals as a result of a reduction in hospital-acquired conditions from 2010 to 2013. The report estimates that the reduction saved approximately $12 billion in healthcare costs. Provisions in the ACA, such as quality incentives, were among the factors said to be driving the improved patient care.  It is estimated that these improvements resulted in 1.3 million fewer hospital-acquired conditions overall.  The report states that the reduction equated to a 70 percent reduction in hospital- acquired conditions over the three-year period. 

HHS Bulletin Addresses HIPAA Privacy Rule in Emergencies (November 2014)
In light of the Ebola outbreak and other events, the Department of Health and Human Services (HHS), Office for Civil Rights, released a bulletin addressing application of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule in emergency situations.   According to HHS, the HIPAA Privacy Rule is not suspended but, “covered entities may disclose, without a patient’s authorization, protected health information about the patient as necessary to treat the patient or to treat a different patient.”  HHS also states that the Privacy Rule recognizes the legitimate need for public health authorities to have access to protected health information to prevent or lessen a serious or imminent threat to the health and safety of a person or the public, among other things.  When disclosing the information in an emergency situation, a covered entity must be cautious to disclose only the “minimum necessary” information.  You can view the entire bulletin at http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/emergencysituations.pdf.

Record Number of Hospitals Assessed Readmission Penalties (November 2014)
CMS recently released information showing that a record 2,610 hospitals were fined under the third round of the Hospital Readmissions Reduction Program.  According to an analysis made available by Kaiser Health News, nearly 18 percent of Medicare patients hospitalized were readmitted within one month.  Further, it is estimated that the readmissions cost Medicare $26 billion -- $17 billion of the costs are estimated to have resulted from potentially avoidable readmissions.    Over the course of the year, it is estimated that the penalized hospitals will be fined a total of $428 million.  Medicare evaluates readmissions for patients initially admitted for elective knee or hip replacements; those suffering lung ailments; patients with heart failure; patients admitted for a heart attack; and patients admitted for pneumonia.  The program began in 2012 and is certain to continue to be examined as a framework to reduce Medicare spending in other areas.

   
Deadline for Meaningful Use Hardship Exemption Approaches (November 2014)
CMS has announced that it has reopened the Meaningful Use hardship exception application period for eligible professionals and hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT).  The deadline for physicians and hospitals to apply is November 30, 2014. 

Eligible professionals and hospitals that have never met meaningful use before may apply if they were unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition CEHRT availability, and could not attest by the early attestation deadline for new participants.  Additional information is available at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html.

Congress Returns for Last Legislative Action of the Year (November 2014)
Following the mid-term elections, the House and Senate have returned from their recess to address some final must-pass legislation, including a funding bill to keep the government open into the New Year.  With power in the Senate set to change hands in 2015 as a result of the elections, it appears that legislative action will be limited.  However, with limited time prior to the end of the year and the swearing-in of the new Congress in January, the ACOI continues to call on Congress to enact meaningful reform of the Medicare physician payment formula.  You can read our correspondence on this and other important issues at www.acoi.org under the “Advocacy” tab

ACOI Member Testifies Before Michigan House Committee (September 2014)
ACOI member Stephen R. Bell, DO, FACOI, appeared before the Michigan House Health Policy Committee to provide testimony on legislation to expand the role of advanced practice registered nurses (APRNs). The legislation under consideration would provide for the licensure of advance practice registered nurses who would include certified nurse midwives, certified nurse practitioners and clinical nurse specialist-certified, among other things.  Specifically, the bill would allow APRNs autonomously to prescribe and administer certain drugs and controlled substances, refer patients to physical and speech therapy services, birth children, diagnose disease and manage patients with chronic illness.
  
Supporters of the legislation suggest that its approval would allow for greater access to needed primary care services in underserved areas.  Opponents of the bill fear that an expansion of the scope of care provided by APRNs without the oversight and collaboration of physicians could put patients’ health and safety at risk.  In his testimony, Dr. Bell recognized the important roll APRNs play on the healthcare delivery team, but noted that patient safety should not be compromised by an increase in scope of practice that is not supported by the training and education received by APRNs.  Following his testimony and that of other witnesses, the Committee Chairwoman noted that there was no schedule for advancing the legislation to the full State House for consideration as a result of the significant questions that still exist regarding the impact of the extension created under the legislation.  The ACOI will continue to closely monitor proposals such as this that could adversely impact patient care through unqualified extensions of scope of practice.

Congressional Schedule in an Election Year (September 2014)
The House and Senate are in session for a brief period of time prior to entering a recess that will run through the November 4 elections.  Following approval of a few must-pass pieces of legislation, including funding of government operations to keep the government open, House and Senate members will return to their districts.  The outcome of the elections will dictate the direction taken by Congress in the “lame duck” session.  Specifically, if control of the Senate changes parties, there will likely be little additional legislative work until early 2015.  

VA Healthcare Legislation Signed into Law (August 2014)
Recent bipartisan efforts led to the approval and enactment of legislation aimed at reforming the delivery of healthcare services to veterans. The President signed into law a $17 billion legislative package that creates 27 new Department of Veterans Affairs (VA) medical facilities; expands care for veterans at non-VA hospitals and clinics when they are unable to quickly receive an appointment or live far from other veterans medical facilities; and allows for the firing of senior executives. The law comes on the heels of revelations that veterans were not receiving healthcare services in a timely fashion at VA facilities across the country. An internal audit by the VA showed that more than 120,000 veterans had not received a medical appointment, or were waiting more than 90 days for care at the time of the audit.

 

Solvency of Medicare Trust Fund Extended (August 2014)
According to a new report released by the Medicare Trustees, the Medicare Hospital Insurance Trust Fund will have sufficient funds through 2030. This represents an increase of four years over the previous estimate released at this time last year. According to CMS, lower-than-expected spending in 2013 and lower-than-anticipated utilization rates have helped slow the growth of Medicare spending per beneficiary. According to the report, Medicare spent $582.9 billion in 2013.

 

$100 Billion in Improper Federal Payments Made (July 2014)
The House Oversight Committee recently held a hearing to examine the extent of improper payments made by the Federal Government. Testimony presented to the Committee estimated that federal agencies made over $97 billion in overpayments and $9 billion in underpayments in 2013 alone. This represents a decrease from the all-time high of $121 billion in improper payments made in 2010. According to testimony, the largest source of improper payments are government health programs. Medicare alone accounted for over $50 billion in improper payments in 2013. Other areas identified for improper payments included the earned income tax credit, Medicaid and Unemployment Insurance, among other areas. The testimony presented is certain to fuel continued efforts by Congress to reign in improper payments made by the Federal Government.

 

Secretary of HHS Sworn in (June 2014)
Sylvia Mathews Burwell was sworn in as Secretary of the Department of Health and Human Services (HHS) on June 9. She replaces outgoing Secretary Kathleen Sebelius who held the position since 2009. Secretary Burwell’s confirmation met little opposition in the Senate where she was confirmed by a strong bipartisan vote of 78 to 17 on June 5. Prior to her confirmation as Secretary, Burwell served as the Director of the Office of Management and Budget.

 

President Nominates New Health and Human Services Secretary (May 2014)
President Obama announced the nomination of Sylvia Mathews Burwell to the recently-vacated position of Secretary of Health and Human Services (HHS) April 11 in the Rose Garden. The nomination came at the same time as the President accepted the resignation of HHS Secretary Kathleen Sebelius. Ms. Burwell is the White House Budget Director. She was confirmed to her current position by the Senate in April 2013 by a vote of 96-0.

 

Prior to her time in the Obama administration, Ms. Burwell was president of the Wal-Mart Foundation and served as President of the Global Development Program at the Bill and Melinda Gates Foundation. Ms. Burwell worked in the Clinton administration as the deputy director of the Office of Management and Budget, deputy chief of staff and chief of staff to the Treasury Secretary, and staff director of the National Economic Council. Her nomination now goes before the Senate for consideration. While her last confirmation sailed through, this one is expected to be contentious in light of ongoing opposition to the Affordable Care Act (ACA). The Senate Committees on Finance and Health, Education, Labor and Pensions will conduct hearings prior to her consideration by the full Senate.

 

House Approves Budget Plan for 2015 (May 2014)
The House approved a budget blueprint for fiscal year 2015 by a vote of 219 - 205. Under the plan, federal spending would be cut by $5.1 trillion over 10 years. This would include significant reductions in Medicare, Medicaid and other health-related programs. Specifically, the plan calls for the following: Medicare would be transitioned to a “premium support” model; Medicaid would be paid for under a block grant system; and the ACA would be repealed, among other things. It is unlikely that this budgetary blueprint will be considered by the Senate. This is just the first of many steps in the budgeting process.

 

Surgeon General Nominee Advances in Senate Committee (March 2014)
The Senate Health, Education, Labor and Pensions Committee (HELP) approved the nomination of Dr. Vivek Murthy to serve as US Surgeon General. While he is expected to be confirmed by the full Senate, his nomination has been slowed by opposition caused by his vocal support for the Patient Protection and Affordable Care Act (ACA) and gun control issues. If confirmed, Dr. Murthy will replace Dr. Regina Benjamin who resigned in July 2013 and will become the 19th Surgeon General.

 

Administration Releases 2015 Budget (March 2014)
The White House issued its fiscal year 2015 budget request on March 4. Included in the request is $1 trillion in federal health spending. The Department of Health and Human Services (HHS) would see a reduction of $1.3 billion. Under the request, the National Institutes of Health would be funded at approximately its current level. In addition, the Centers for Disease Control would be cut by six percent. The President has, however, requested $5.2 billion over 10 years to be invested to fund 13,000 residency positions and improve access to primary care. Unfortunately, the request also includes a 10 percent reduction in Indirect Medical Education (IME) payments to teaching hospitals. Finally, the budget proposal would extend through 2015 a requirement that state Medicaid programs pay primary care at Medicare rates.

 

The budget proposal is a mixed bag for physicians and medical training. While the President’s budget proposal offers a blueprint for what he would like to see in federal spending, it is unlikely that many of the provisions contained therein will be enacted. Congress is now at work putting together budgets for each of the federal departments that comprise the federal government. It is a process that takes months. The ACOI will continue to monitor budget negotiations that affect physicians and their patients.

 

Chair of Influential Senate Committee Receives Chinese Ambassadorship (February 2014)
After serving more than 35 years in the Senate, the Senate voted 96-0 in favor of Max Baucus’ (D-MT) nomination to become US Ambassador to China. Ambassador Baucus served on the Senate Finance Committee and was instrumental in the advancement of far-reaching legislation. He helped shape healthcare legislation for more than three decades. His impact is certain to remain for years to come. Senator Ron Wyden (D-OR) will be the next Chairman of this influential committee.

 

HHS Secretary Calls on OIG to Investigate Development of Healthcare Website (January 2014)
HHS Secretary Kathleen Sebelius sent a letter to the HHS Inspector General Daniel R. Levinson requesting a review of the implementation and launch of the Healthcare.gov website. Specifically, Secretary Sebelius requested the following areas be reviewed: the acquisition process for the contractors responsible for Healthcare.gov; the administration of contractors, as well as the project management of the Healthcare.gov website; how the contractors performed their duties, how they were supervised and how they were paid; and, whether the contractors met the terms of their original contracts. The OIG has not responded to date to Secretary Sebelius’ request.

 

Legislation Reauthorizing Poison Control Programs Advances (January 2014)
The House approved the “Poison Center Network Act” (H.R. 3527) by a vote of 388-18 on January 8. The legislation authorizes $700,000 over five years to fund the national poison control hotline. In addition, the bill provides $800,000 to fund a national media campaign. Finally, H.R. 3527 authorizes $29 million annually from fiscal year 2015 through 2019 for a poison control grant program that would benefit the activities of poison control centers across the country. Authorization and funding for the national poison control programs was last reauthorized in 2008 and expires at the end of fiscal year 2014. The bill now awaits Senate consideration.

 

Health Spending Growth Continues to Slow (January 2014)
According to a report released by CMS, healthcare spending rose by just 3.7 percent in 2012. This marks the fourth consecutive year of slow growth for US healthcare spending. According to the report, healthcare spending in 2012 was $2.8 trillion. This equates to $8,915 per person. In addition, the share of the gross domestic product (GDP) associated with healthcare spending dropped from 17.3 percent to 17.2 percent. According to CMS, growth in healthcare spending has remained stable since 2009, rising between 3.6 percent and 3.8 percent annually. The full report can be viewed at www.cms.gov/Research-Statistics-Data-and-Systems/Statistics....

 

2013

Congressional Budget Office Announces No Further Budget Updates (July 2013)
The non-partisan Congressional Budget Office (CBO) has announced that it will not release an August update to its budget projections. The CBO indicated that there is little new information since the release of the May report that would alter its prior estimates. This is significant as it relates to Congress’ ongoing efforts to reform the manner in which physicians are reimbursed under the Medicare program. The estimated cost to address the Medicare physician payment system will remain at approximately $139.1 billion over 10 years. This is about $100 billion under last year’s estimates. As a result, Congress can continue its negotiations without concern for an increase in the cost estimate to address the Medicare physician payment formula. This provides an opportunity for this matter to be addressed once and for all at the lower price.

 

Supreme Court Rules Genes are not Patentable (July 2013)
In a unanimous decision, the U.S. Supreme Court ruled in Association for Molecular Pathology v. Myriad Genetics, Inc., that human genes are not patentable. The Court considered the legality of patents issued for the BRCA1 and BRCA2 genes and found that patent protections cannot be extended to genes found in nature. Justice Clarence Thomas stated, “To be sure, it [Myriad] found an important and useful gene, but separating that gene from surrounding genetic material is not an act of invention.” The Court’s decision removes a potential barrier for patients and researchers to access new tests and treatments that rely on technologies based on the human genome.

 

Medicare Trustee Report Extends Medicare Solvency (June 2013)
According to a report released on May 31, the Medicare Hospital Insurance Trust Fund will remain solvent through 2026. This represents an additional two years over last year’s report. The report entitled, “2013 Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Fund,” suggests caution due to the many uncertainties that remain. For instance, the report assumes that the Medicare physician reimbursement formula will remain in place in its current form. If Congress acts to freeze or increase Medicare rates, overall Medicare spending will increase and impact the long-term solvency estimates of the program. Reforming Medicare is certain to continue to receive a great deal of attention from Congress. Any changes implemented by Congress will impact the estimates outlined in the report.

 

Tavenner Confirmed as Head of CMS (June 2013)
Marilyn Tavenner was confirmed by the Senate to lead the Centers for Medicare and Medicaid Services (CMS) on May15. Her nomination was approved by a vote of 91-7. Tavenner is the first confirmed CMS administrator since Mark McClellan held the position in 2004 through 2005 under President George W. Bush. The nomination was stalled twice before clearing the Senate with strong bipartisan support. In addition to overseeing the Medicare and Medicaid programs, Administrator Tavenner is also responsible for implementing significant parts of the Patient Protection and Affordable Care Act (ACA, Pub. L. 111-152). She is the first democratic nominee approved in over 15 years. Prior to her confirmation, Tavenner served as Acting Administrator for more than a year.

 

Hospital Readmission Rates Decline Under Medicare (June 2013)
According to a report recently released by CMS, hospital readmission rates for fee-for-service Medicare beneficiaries fell in 2012. Rehospitalization within 30 days of discharge from an inpatient stay for Medicare beneficiaries fell from 19 percent in 2007 – 2011 to 18.4 percent in 2012. CMS estimates that the reduction in readmissions equated to approximately 70,000 fewer readmissions last year. It was also noted by CMS that hospitals participating in the Partnership for Patients Program were more likely to have lower readmission rates than those not participating the Program.

 

ACOI President Advocates on Behalf of Profession (June 2013)
ACOI President Robert G. Good, DO, FACOI, recently visited Washington, DC to meet with congressional leaders. During two days of meetings with key congressional staff and others, Dr. Good spoke on the importance of advancing meaningful reform for Medicare physician reimbursement; expanding graduate medical education; increasing access to affordable quality care; and reducing regulatory burdens. Concern was expressed by Dr. Good that the ever-increasing regulatory requirements are counter-productive and negatively impact quality, efficiency and access to care by diverting limited resources. Dr. Good emphasized the importance of ensuring that healthcare reform efforts are not overly complicated, thus predisposing them to failure. In addition, he informed those with whom he met that the ACOI stands ready to assist congressional efforts to ensure that patients have access to high quality care.

 

Tavenner Nomination Hits Roadblock (May 2013)
As reported earlier, President Obama renominated Marilyn Tavenner to be Administrator of the Centers for Medicare and Medicaid Services on February 7. Following a unanimous voice vote by the Senate Finance Committee, it appeared that Tavenner’s nomination was on track for a speedy confirmation vote by the full Senate. Prior to a vote by the full Senate, Senator Tom Harkin (D-IA) placed a hold on the nomination preventing it from consideration. Senator Harkin indicated that he placed the hold on the nomination in order to force the Administration into a dialogue with him regarding its efforts to siphon funds from the ACA’s Prevention and Public Health Fund to fund other parts of the ACA. Senator Harkin has been a proponent of the Fund and its purpose in advancing health. He has since announced that he has lifted his hold. As such, the Senate is expected to consider Marilyn Tavenner’s nomination shortly.

 

CMS Acting Administrator Renominated (March 2013)
President Obama renominated Marilyn Tavenner to be Administrator of the Centers for Medicare and Medicaid Services on February 7. She was first nominated in November 2011 following the departure of CMS Administrator Donald Berwick, MD. She also served as Acting Administrator prior to Dr. Berwick’s recess appointment in July, 2010. Prior to her time at CMS, Ms. Tavenner served as the Commonwealth of Virginia’s Secretary of Health and Human Resources. She holds a Bachelor of Science degree in nursing and a Masters in Health Administration. A confirmation hearing date has not been set. Senate Finance Committee Chairman Max Baucus announced his intention to hold a confirmation hearing shortly. There has not been a Senate-confirmed CMS administrator since 2006.

 

Medical Disaster Legislation Advances (March 2013)
The Senate and House approved the “Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (H.R. 307) by unanimous consent with amendment and by a vote of 370-28, respectively. The bill now goes to the President where it is expected to be signed into law. H.R. 307 strengthens national preparedness and response for public health emergencies and optimizes state and local hazard preparedness and response activities. In addition, the legislation enhances medical countermeasure efforts by the FDA and accelerates medical countermeasures research and development, among other things. The legislation reauthorizes the programs originally established under the Project BioShield Act (Pub. Law 108-276)

 

Census Bureau Releases Report Detailing Health Insurance Coverage (October 2013)
According to a report recently released by the US Census Bureau, the percentage of people without health insurance coverage declined in 2012. The report indicates that people without coverage declined to 15.4 percent, down from 15.7 percent in 2011. Further, the percentage of people with health insurance increased to 84.6 percent (263.2 million), up from 84.3 percent (260.2 million) during the same time period. A copy of the report, which details the characteristics of the uninsured, is available at www.census.gov.

 

Growth in Federal Healthcare Program Spending Slows (February 2013)
The non-partisan Congressional Budget Office (CBO) released a report entitled, “The Budget and Economic Outlook: Fiscal Years 2013 to 2023.” According to the report, Medicare spending grew by three percent in 2012. This represents the slowest rate of growth since 2000. The same report found that if the current physician pay structure stays in place, physicians’ fees will be reduced by about 25 percent in January 2014 and will increase by small amounts in subsequent years. It is important to note that the CBO report reduced the projected cost of freezing physician reimbursement rates between 2014 and 2023 from $245 billion to $138 billion. This reduced cost estimate presents an opportunity for Congress to act on reforming the Medicare physician reimbursement structure under reduced cost constraints.

 

Growth in Federal Healthcare Program Spending Slows (February 2013)
The non-partisan Congressional Budget Office (CBO) released a report entitled, “The Budget and Economic Outlook: Fiscal Years 2013 to 2023.” According to the report, Medicare spending grew by three percent in 2012. This represents the slowest rate of growth since 2000. The same report found that if the current physician pay structure stays in place, physicians’ fees will be reduced by about 25 percent in January 2014 and will increase by small amounts in subsequent years. It is important to note that the CBO report reduced the projected cost of freezing physician reimbursement rates between 2014 and 2023 from $245 billion to $138 billion. This reduced cost estimate presents an opportunity for Congress to act on reforming the Medicare physician reimbursement structure under reduced cost constraints.

 

Sunshine” Act Final Rule Issued (February 2013)
The Centers for Medicare and Medicaid Services (CMS) released the final rule implementing the “National Physician Payment Transparency Program: Open Payments” on February 1. The final rule implements the Sunshine Act included in the “Patient Protection and Affordable Care Act” (ACA, Pub. Law 111-152). According to a release issued by CMS, “You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need.” The release goes on to state, “Disclosure of these relationships allows patients to have more informed discussions with their doctors.” The final rule requires manufacturers of drugs, devices, biologics and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report to CMS payments or other transfers of value they may make to physicians and teaching hospitals. According to the rule, collection of the data will begin on August 1, 2013 with data being posted on a public website by September 30, 2014. The final rule is available for review at http://www.gpo.gov/fdsys/pkg/FR-2013-02-08/pdf/2013-02572.pdf.

 

Legislation Introduced to Repeal IPAB (February 2013)
The “Protecting Seniors Access to Medicare Act of 2013” (H.R. 351) was introduced in the House on January 23. The legislation would repeal the Independent Payment Advisory Board (IPAB) established under the ACA. H.R. 351 has been referred to the House Committees on Ways and Means, Energy and Commerce and Rules. To date, additional action has not been scheduled for H.R. 351. Similar legislation was approved by the House in 2012. The Senate did not take action.

 

CMS Program Identified and Prevented $115 Million in Fraud (January 2013)
CMS announced that the newly-operational Fraud Prevention System helped stop, prevent, or identify roughly $115 million in fraudulent payment during its first year of operation. According to CMS, the system helped identify 536 leads that have lead to 511 ongoing investigations. The system uses predictive modeling and data analytics to review all Medicare fee-for-service claims for indications of fraud.

 

CBO Report Shows Link Between Prescription Drug Coverage and Medicare Spending (January 2013)
The non-partisan Congressional Budget Office (CBO) released a report entitled, “Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services.” In the report, the CBO estimates that for every one percent increase in the number of prescriptions filled by Medicare beneficiaries, there is a 0.2 percent reduction in spending for medical services. Similarly, the CBO estimates that for every one percent reduction in prescription drug use there is a 0.2 percent increase in medical spending. The CBO has estimated that the PPACA’s provision to close the Medicare Part D coverage gap (“doughnut hole”) will result in an increase in prescription drug consumption by about five percent. This equates to about a one percent decrease in Medicare spending on Medical services by 2018. The report goes on to estimate that federal spending on prescription medications will increase by $86 billion from 2013-2022 with an offset of $35 billion created by a reduction in medical spending. The CBO has announced that it will include the offset calculation in the future when it estimates the budgetary impact of legislation or proposals affecting the number of prescriptions filled. You can review the report in its entirety at www.cbo.gov.

 

2012

CBO Report Shows Link Between Prescription Drug Coverage and Medicare Spending (December 2012)
The non-partisan Congressional Budget Office (CBO) released a report entitled, “Offsetting Effects of Prescription Drug Use on Medicare’s Spending for Medical Services.” In the report, the CBO estimates that for every one percent increase in the number of prescriptions filled by Medicare beneficiaries, there is a 0.2 percent reduction in spending for medical services. Similarly, the CBO estimates that for every one percent reduction in prescription drug use there is a 0.2 percent increase in medical spending. The CBO has estimated that the PPACA’s provision to close the Medicare Part D coverage gap (“doughnut hole”) will result in an increase in prescription drug consumption by about five percent. This equates to about a one percent decrease in Medicare spending on Medical services by 2018. The report goes on to estimate that federal spending on prescription medications will increase by $86 billion from 2013-2022 with an offset of $35 billion created by a reduction in medical spending. The CBO has announced that it will include the offset calculation in the future when it estimates the budgetary impact of legislation or proposals affecting the number of prescriptions filled. You can review the report in its entirety at www.cbo.gov.

 

New Report Finds Increase in Federal Spending for Poor (November 2012)
According to a new report released by the non-partisan Congressional Research Service (CRS), federal health care spending for the low-income population increased by 37 percent between fiscal years 2008 and 2011. The same report found that overall federal spending on poverty programs increased by 33 percent. According to CRS, spending on Medicaid and the Children’s Health Insurance Program (CHIP) totaled $339.4 billion in fiscal year 2011 compared to $247.7 billion in fiscal year 2008. The report indicated that the amount spent on healthcare exceeded that spent on any other single category, including food assistance, education, housing, energy and cash assistance. In all, the report examined 83 different federal programs aimed at helping the poor.

 

HHS Find Medicare Beneficiaries Saved on Prescription Drugs (November 2012)
The US Department of Health and Human Services (HHS) announced that since the enactment of the PPACA, 5.6 million seniors and people with disabilities have saved $4.8 billion on prescription drug costs. According to HHS, beneficiaries have saved on average $657 on prescription drugs during the first nine months of 2012. In addition, HHS announced that 20.7 million Medicare beneficiaries received at least one preventive care service.

 

Number of Uninsured Decreases (October 2012)
A report recently released by the US Census Bureau found that the number of people without health insurance decreased in 2011. According to Census Bureau statistics, 48.6 million Americans lacked health insurance coverage in 2011, down from 50 million in 2010. The same report found that a total of 260.2 million people had health insurance coverage in 2011, up from 256.6 million in 2010. The rate of private health insurance coverage held steady, while the percentage of people receiving coverage through government health programs such as Medicare and Medicaid increased. You can view all of the Census Bureau’s health data at www.census.gov.

 

Budget Sequestration to Cut Health Care Spending (October 2012)
The Office of Management and Budget (OMB) released a report required by the Budget Control Act of 2011 (BCA, Pub. L. 112-25) detailing the impact of sequestration (automatic across-the-board spending cuts required by current federal law.) If sequestration is allowed to occur, the OMB estimates Medicare provider spending will be reduced by $11.1 billion in fiscal year 2013. The report indicates that mandatory Medicare Part A spending would be reduced by $5.6 billion; mandatory Medicare Part B would be cut by $4.9 billion; Part A discretionary spending would be cut by $179 million; and Part B discretionary spending would be cut by $281 million, among other reductions. The law limits Medicare reductions to two percent. It is important to note that the reductions caused by sequestration will be in addition to the reductions scheduled for January 1 under the Medicare sustainable growth rate (SGR) formula. While there is agreement on both sides of the aisle that allowing these reductions to go into effect on January 2, 2013 would be destructive, it remains contentious as to how to repeal the law. The ACOI has joined with a number of other physician organizations calling on Congress to act prior to the implementation of these cuts. The ACOI will continue to advocate for appropriate compensation for its members.

 

Congressional Leaders Agree on Government Funding Extension (August 2012)
The current fiscal year for the Federal Government ends September 30. To date, no appropriation bills have been signed into law for the 2013 fiscal year. In an effort to prevent the threat of a governmental shutdown prior to the elections, House and Senate leaders announced an agreement that will fund the government from October 1, 2012 through March 30, 2013. The agreement is expected to be drafted and considered in September as a continuing resolution. The agreement, which would provide $1.047 trillion in spending, does not include any provisions addressing future physician reimbursement reductions under the Medicare program. As a result, separate legislation will be required to address scheduled reductions.

 

Individuals Selected for Innovation Advisors Program (January 2012)
CMS announced the selection of the first group of healthcare experts to participate in its Innovation Advisors Program. Participants are expected to test new models to improve care within federal healthcare programs. In all, CMS announced the selection of 73 individuals from 27 states and the District of Columbia to participate in the program. The advisors will work directly with the Center for Medicare and Medicaid Innovation (CMMI). The CMMI and funding for the program was created under the PPACA. In all, as many as 200 individuals will be selected to participate in the first year of the program. Participant’s organizations will receive a stipend of up to $20,000. For more information on the program, you can visit http://innovations.cms.gov/

 

2011

CMS Issues Final Rule Giving Access to Medicare Claims Data (December 2011)
CMS announced a final rule on December 7 providing access to Medicare claims data by “qualified entities.” The purpose of the access is to facilitate the aggregation of Medicare claims data to provide healthcare provider and supplier performance reports. The final rule is a result of provisions contained in the PPACA drafted to advance improved transparency to assist consumers. The final rule takes effect January 6.

 

Deficit Reduction Committee Fails to Reach Agreement (December 2011)
The Joint Select Committee on Deficit Reduction created under the “Budget Control Act of 2011” (S. 365, Pub. L. 112-25) failed to reach agreement on how to reduce federal spending by $1.5 trillion over 10 years. The deadline to do so was November 23. Without congressional intervention, across-the-board reductions will begin on January 2, 2013. In announcing its inability to reach compromise the co-chairs of the committee stated, “After months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee’s deadline.” It is uncertain whether Congress will intervene to prevent the triggered cuts. Under the law, Medicare reductions are limited to two percent.

 

Head of CMS Steps Down, New Nominee Announced (December 2011)
CMS Administrator Donald Berwick, MD, announced his departure from CMS effective December 2. Principle Deputy Administrator Marilyn Tavenner was announced as President Obama’s nominee to fill the position. Ms. Tavenner served as Acting Administrator prior to Dr. Berwick’s recess appointment in July, 2010. Prior to her time at CMS, Ms. Tavenner served as the Commonwealth of Virginia’s Secretary of Health and Human Resources. She holds a Bachelor of Science degree in nursing and a Masters in Health Administration. A confirmation hearing date has not been set.

 

Census Bureau Releases Data on Uninsured (November 2011)
According to data recently released by the U.S. Census Bureau, the number of people without health insurance coverage rose from 49.0 million in 2009 to 49.9 million in 2010. In addition, the Bureau reported that the number of people with health insurance increased from 255.3 million in 2009 to 256.2 million in 2010. During the same time, the percentage of people covered by private health insurance declined from 64.5 percent to 64 percent. The percentage of individuals covered by government health insurance increased from 30.6 percent to 31 percent. The Census Bureau data indicate that household income declined in 2010 and the poverty rate increased to 15.1 percent from 14.3 percent in 2009. For additional information on the recently released data you may visit www.census.gov.

 

FDA Issues Draft Guidance on Mobile Medical Apps (August 2011)
The Food and Drug Administration (FDA) issued draft guidance on how it will oversee mobile medical applications “apps” designed for use on smart phones and other mobile computing devices on July 19. The FDA indicated that it will not regulate the sale or general consumer use of smart phones or tablets. According to a recent study, 500 million users worldwide will be using a health care application by 2015. The draft guidance applies specifically to the following: apps that are used as an accessory to medical devices already regulated by the FDA; and apps that transform a mobile communication device into a regulated medical device by using attachments, sensors or other devices. You can view the full proposal at www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ucm255978.htm.

 

Federal Government Avoids Default (August 2011)
The President signed into law the “Budget Control Act of 2011” (S. 365, Pub. L. 112-25) on August 2, just hours before the government began to default on some of its financial obligations. The House approved the legislation on August 1 by a vote of 269 to 161. The Senate approved S. 365 on August 2 by a vote of 74 to 26. While the compromised legislation provided a temporary solution, it left many other problems on the table.
The legislation increased the debt limit by $900 billion, $400 billion of which is available immediately. Once the federal debt comes to within $100 billion of the debt ceiling the President may ask for an additional $1.2 trillion, which could rise to $1.5 trillion under certain circumstances. Central to the legislation is a Joint Select Committee on Deficit Reduction that is to propose at least $1.5 trillion in budgetary savings over 10 years. If the Committee fails to produce a recommendation that is approved by the House and Senate by December 23, a “trigger” will create automatic across-the-board reductions.

 

S. 365 addresses educational funding as well. Specifically, the Act eliminates the interest subsidy on subsidized student loans for almost all graduate students while a barrower is in school, in the post-school grace period, and during any authorized deferment period beginning July 1, 2012. In addition, beginning July 1, 2012, the Act terminates the Secretary of Education’s authority to make incentive payments to borrowers to encourage the on-time repayment of their federal loans. The current interest rate reduction will still be allowed for those who agree to repay their loans through electronic debiting.

 

The legislation does not include a mechanism to replace Medicare’s Sustainable Growth Rate (SGR) formula. In fact, if the Joint Commission fails to produce a package that is agreed to by both the House and Senate, physicians may face an additional two percent reduction on top of the 29.5 percent reduction projected for January 1, 2012. The ACOI will continue to closely monitor these negotiations.

 

New Study Reveals Cost of Physicians Dealing with Insurers (August 2011)
According to a new study entitled, “U.S. Physician Practices Versus Canadians: Spending Nearly Four Times as Much Money Interacting with Payers,” the annual cost per U.S. physician to interact with payers is $82,975. Conversely, the annual cost per physician in Ontario, Canada is $22,205. Other findings of the study include: U.S. physicians spend an additional 1.2 hours per week interacting with health plans; nurses and medical assistants spend nearly 10 times more time on administrative tasks related to health plans per week; and U.S. clerical staff spend an additional 37.2 hours per week per physician more than their Canadian counterparts. The study estimates that these discrepancies cost the U.S. at least $31 billion per year. The study, which was partially funded by the Commonwealth Fund, is available at www.commonwealthfund.org.

 

HHS Announces New Approach To Fraud Prevention (July 2011)
Secretary of Health and Human Services Kathleen Sebellius announced that HHS will begin using new analytic technology aimed at identifying fraudulent claims on July 1. According to the Secretary, the technology will be used to analyze the 4.5 million claims that are submitted daily. The new technology uses the same type of predictive modeling that has been used to curb credit and property-casualty insurance fraud. Risk-scoring technology will be applied to each fee-for-service Medicare claim when it is submitted, using real-time data to identify and analyze billing patterns and evaluate the validity of each claim. According to Peter Budetti, Director, CMS Center for Program Integrity, the risk score alone will not result in a denied claim, but will be used to identify which claims need to be looked at more closely. In announcing the new initiative Secretary Sebellius stated, “Suddenly, it is a lot harder for the rotten apple to blend in with the bunch.”

 

New Free Health Information Available through the National Library of Medicine (July 2011)
The National Library of Medicine (NLM) announced a new free service called MedlinePlus Connect. MedlinePlus Connect is a service of the NLM, the National Institutes of Health (NIH) and the Department of Health and Human Services (HHS) that allows health organizations and health information technology providers to link patient portals and electronic health record systems to MedlinePlus, an authoritative up-to-date health information resource for patients, families and healthcare providers.
MedlinePlus Connect is available as a Web application or a Web service. According to the NLM, Medline Plus has hundreds of health topic pages that bring together information from NIH, other government agencies and reputable health information providers. Additional information is available at www.nlm.nih.gov/medlineplus/connect/overview.html.

 

New Appointments to the Medicare Payment Advisory Commission Announced (June 2011)
The Government Accountability Office (GAO) announced the appointment of two new members to the Medicare Payment Advisory Commission (MedPAC) on May 31. In addition, three existing members were reappointed to the Commission. The newly appointed members are: Willis D. Gradison, Jr., MBA, a Scholar in Residence in the Health Care Sector Management Program at Duke University’s Fuqua School of Business and William J. Hall, MD, a geriatrician and Professor of Medicine at the University of Rochester School of Medicine. Their terms will expire in 2014. MedPAC was created by Congress to advise it on issues related to access to care, cost and quality of care, and other key issues affecting Medicare.

 

Report Estimates Reduced Solvency of Medicare Hospital Insurance Trust Fund (June 2011)
A report recently released by the Centers for Medicare and Medicaid Services (CMS) projects the Medicare Hospital Insurance Trust Fund will remain solvent through 2024. The 2011 Medicare Trustees Report projects the solvency of the fund decreased by five years from the previous report issued in 2010. According to the report, the five-year reduction in solvency is a result of the slowdown in the national economy and the resulting decline in tax revenues and an increase in future expenditures. The full report can be accessed at www.cms.gov.

 

Senate Votes Down House Budget Resolution (June 2011)
The Senate rejected a motion to consider the House-approved budget resolution (H. Con. Res. 34) by a vote of 40-57 on May 25. As previously reported, the resolution establishes the budget framework for fiscal year 2012 and calls for about $6 trillion in spending cuts over the next decade, among other things. The vote was intended to place republicans on record as supportive of the resolution’s provision to reform the Medicare program by creating a voucher program for future Medicare beneficiaries. Budget negotiations are ongoing and are expected to last through much of the year.

 

House Approves 2012 Budget Resolution (May 2011)
The House approved H. Con. Res. 34 on April 15 by a vote of 235-193. The resolution establishes the budget framework for fiscal year 2012. The resolution calls for about $6 trillion in spending cuts over the next decade and would reduce the top income tax rate to 25 percent. The plan would also reduce domestic discretionary spending to levels below fiscal year 2008 levels. In addition, the budget resolution would reform the Medicare program by creating a voucher program for future Medicare beneficiaries. Budget negotiations are expected to last through much of the year.

 

2011 Appropriations Bill Signed into Law (May 2011)
The House and Senate avoided a shutdown of the federal government by approving the “Full-Year Continuing Appropriations Act of 2011” (H.R. 1473, Pub. L. 112-10). After numerous continuing resolutions and returning from the brink of a shutdown, democrats and republicans agreed to a compromise package that funds the government through September 30, 2011. The Act provides $1.055 trillion for fiscal year 2011 and reduces spending by $39.9 billion over fiscal year 2010 levels. As part of the negotiations to approve H.R. 1473, the House and Senate agreed to consider legislation (H. Con. Res. 35) to block funding for the implementation of the “Patient Protection and Affordable Care Act” (ACA, Pub. L. 111-148). The Senate rejected the resolution by a vote of 47 to 53. The House approved the resolution by a vote of 240 the 185. H. Con. Res. 35 will not advance to the President’s desk.

 

The ACOI has joined the Partnership for Patients, which brings together hospitals, employers, physicians, nurses and patient advocates in a shared effort to improve patient safety and healthcare efficiency. The goals of the Partnership are to keep patients from getting injured or sick and to help patients heal without complication. The Partnership aims to decrease hospital-acquired conditions by 40% by the end of 2013. In addition, the Partnership intends to reduce hospital readmissions by 20% over the same time period. It has been estimated that achieving these goals will reduce healthcare costs by approximately $35 billion with a $10 billion savings to the Medicare program and additional savings over the next 10 years. You can learn more about the Partnership by visiting www.healthcare.gov.

 

Continuing Resolution Keeps Government Open for Business (March 2011)
President Obama signed the latest continuing resolution (H.J. Res. 48) to fund the Federal Government into law on March 18. The continuing resolution includes $6.1 billion in cuts and runs until April 8. The funding bill was signed into law just hours before the government would have shut down. With the additional time, both the House and Senate must find common ground to fund government operations for the last six months of the 2011 fiscal year. H.J. Res. 48 was the fifth continuing resolution passed by Congress since October 2010. A government shutdown remains a possibility as Congress continues to negotiate the size of reductions in federal spending. Congress must also address the fiscal year 2012 budget.

 

Berwick Renominated to Head CMS (February 2011)
President Obama renominated Donald Berwick to be Administrator of CMS. He was first nominated in April 2010 and was later named to the position in July 2010 as a recess appointment following a refusal by the minority to consider his nomination. Dr. Berwick’s recess appointment will expire at the end of 2011. To date, a confirmation hearing has not been scheduled by the Senate Finance Committee. CMS has been without a permanent administrator since 2006.

 

2010

Osteopathic Physician Elected to Congress (December 2010)
Osteopathic physician Joe Heck, D.O. became the first osteopathic physician elected to the United States House of Representatives since 1939. Dr. Heck is an emergency room physician in Henderson, Nevada. He will join 19 other physicians serving in the 112th Congress. There will be 17 physicians in the House and three physicians in the Senate. This represents the largest number of physicians ever to serve in Congress at one time.

 

FDA Announces Changes to Cigarette Labels (December 2010)
The Food and Drug Administration (FDA) announced a new comprehensive tobacco control strategy on November 10. According to the FDA, the strategy is the most significant change to address tobacco use in over 25 years. Under the changes announced by the FDA, tobacco companies will be required to add color graphics and warnings to cigarette boxes and advertisements telling consumers that smoking can kill. Manufacturers that fail to include the color graphics will be prohibited from selling cigarettes in the United States by October 22, 2012. The new graphic photos and images will be required to cover 20% of all tobacco print ads and half the size of cigarette packs. Nine images will be chosen from 36 potential images released by the FDA. Cigarette makers will be required to rotate the nine final images. The final rule is expected out by late June, 2011. You may view the proposed images at www.fda.gov.

 

Number of Uninsured Continues to Grow (October 2010)
According to data just released by the US Census Bureau in a report entitled, “Income, Poverty, and Health Insurance Coverage in the United States,” there were approximately 50.7 million people in the United States without healthcare coverage in 2009. This is an increase from the 2008 levels of 46.3 million. The Census Bureau reports that 2009 saw the largest number of uninsured individuals since the Bureau began keeping statistics in 1987. In addition, the total number of individuals with coverage fell from 255.1 million in 2008 to 253.6 million in 2009. This is the first time the total number of individuals with coverage decreased from year-to-year. The report noted that the percentage of people covered by private and employment-based coverage decreased. Coverage through government health insurance programs such as Medicare, Medicaid, the Children’s Health Insurance Program and military coverage increased for the third straight year. This report and other data is available at www.census.gov/.

 

Patient-Centered Outcomes Research Institute Board Named (October 2010)
The U.S. Government Accountability Office (GAO) announced the members of the Patient-Centered Outcomes Research Institute Board (PCORI) on September 23. The PCORI was created by the “Patient Protection and Affordable Care Act” (ACA, Pub. L. 111-148) to perform comparative effectiveness research. The board consists of 19 members representing the following constituencies: three represent patients or healthcare consumers; seven from the physician or medical provider community; three from private payers; three from pharmaceutical, device or diagnostic test companies; one quality improvement or health service researcher; and, two from federal or state governments. Eugene Washington, MD, MSc, Vice Chancellor, UCLA Health Sciences and Dean, Geffen School of Medicine, was named chair of the PCORI board of governors.

 

New Physician Shortage Estimates Released (October 2010)
The Association of American Medical Colleges’ (AAMC) Center for Workforce Studies released new physician shortage estimates on September 30. According to the new estimates released by the AAMC, the current physician shortage will be exacerbated by an additional 32 million Americans having access to healthcare coverage combined with an ever-expanding pool of Medicare enrollees. The AAMC estimates that there will be a shortage of over 36,000 physicians by 2015. In the release announcing the new estimates the AAMC stated, “Unless Congress supports at least a 15 percent increase in residency training slots (adding another 4,000 physicians a year to the pipeline), access to healthcare will be out of reach for many Americans.” Physician-shortage concerns remain an important issue for Congress to address. The ACOI continues to work to promote the expansion of residency training slots and the availability of healthcare services.

 

Acting Head of Center for Medicare and Medicaid Innovation Named (October 2010)
The Centers for Medicare and Medicaid Services (CMS) announced that Richard Gilfillan, MD was named as the Acting Director of the Center for Medicare and Medicaid Innovation. The Center was created by the ACA to test payment and delivery system models to improve quality and control costs in public health insurance programs. Dr. Gilfillan was director of the performance-based payment policy staff at CMS at the time of his appointment. Prior to his roles at CMS, he served as president and chief executive officer of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System. It is not clear whether Dr. Gilfillan’s appointment will be made permanent.

 

Prevention and Public Health Council Created by Executive Order (July 2010)
The President created the National Prevention, Health Promotion and Public Health Council by Executive Order on June 10. The Council, comprised of Cabinet members and other top officials, is charged with developing and making public a national prevention, health promotion and public health strategy that is to be reviewed annually. The Surgeon General serves as the Chair of the Council which is housed within the Department of Health and Human Services.

 

President Appoints Head of CMS (July 2010)
President Obama appointed Donald Berwick, MD, as Administrator of the Centers for Medicare and Medicaid Services on July 7. Dr. Berwick was previously nominated on April 7 for the position.

 

Dr. Berwick is a pediatrician by training and was most recently the president and CEO of the Institute for Healthcare Improvement. He was also a professor at Harvard Medical School and the Harvard School of Public Health. A recess appointment is used from time-to-time to place an individual into a position in a more expeditious fashion. The appointment expires at the end of the Congressional session, which will be the end of calendar year 2011. President Obama re-nominated Dr. Berwick for confirmation by the Senate on July 19. Dr. Berwick will be responsible for overseeing much of the implementation of the “Patient Protection and Affordable Care Act” (PPACA, Pub.L. 111-148). Dr. Berwick is a recognized expert in health system reform.

 

IRS Announces Tax Incentive for Those Who Work in Underserved Areas (July 2010)
The Internal Revenue Service (IRS) announced efforts to strengthen the healthcare workforce in underserved areas on June 16. The IRS announced that, "Under the Affordable Care Act healthcare professionals who received student loan relief under state programs that reward those who work in underserved communities may qualify for refunds on their 2009 federal income returns as well as an annual tax cut going forward." Prior to the enactment of the "Patient Protection and Affordable Care Act," only amounts received under the National Health Service Corps Loan Repayment and Forgiveness Program were eligible for the tax benefit. As a result of this legislation, the tax exclusion applies to any state loan repayment or loan forgiveness programs intended to increase the availability of healthcare services in underserved or health professional shortage areas. Additional information is available from the IRS at www.irs.gov/newsroom/article/0,,id=224387,00.html.

 

Prevention and Public Health Council Created by Executive Order (July 2010)
The President created the National Prevention, Health Promotion and Public Health Council by Executive Order on June 10. The Council, comprised of Cabinet members and other top officials, is charged with developing and making public a national prevention, health promotion and public health strategy that is to be reviewed annually. The Surgeon General serves as the Chair of the Council which is housed within the Department of Health and Human Services.

 

Patient Bill of Rights Released (July 2010)
Interim final rules implementing certain consumer protections contained in the "Patient Protection and Affordable Care Act" were issued on June 22. The rules are effective August 27. Under the new "Patient Bill of Rights" insurance companies are prohibited from imposing pre-existing condition exclusions on children, prevention policy rescissions for unintentional mistakes on an application for insurance coverage, may not set lifetime limits on coverage and the use of annual limits on coverage, is restricted, among other things. You may view a fact sheet on the "Patient Bill of Rights," at www.whitehouse.gov/sites/default/files/Consumer%20reg%20Fact%20Sheet.pdf.

 

President Appoints Head of CMS (July 2010)
President Obama appointed Donald Berwick, MD, as Administrator of the Centers for Medicare and Medicaid Services on July 7. Dr. Berwick was previously nominated on April 7 for the position.

 

Dr. Berwick is a pediatrician by training and was most recently the president and CEO of the Institute for Healthcare Improvement. He was also a professor at Harvard Medical School and the Harvard School of Public Health. A recess appointment is used from time-to-time to place an individual into a position in a more expeditious fashion. The appointment expires at the end of the Congressional session, which will be the end of calendar year 2011. President Obama re-nominated Dr. Berwick for confirmation by the Senate on July 19. Dr. Berwick will be responsible for overseeing much of the implementation of the "Patient Protection and Affordable Care Act" (PPACA, Pub.L. 111-148). Dr. Berwick is a recognized expert in health system reform.

 

Harvard Professor Nominated to Head CMS(June 2010)
President Obama nominated Donald Berwick, MD as Administrator of the Centers for Medicare and Medicaid Services. Dr. Berwick is a pediatrician by training and is currently the president and CEO of the Institute for Healthcare Improvement. He is a professor at Harvard Medical School and the Harvard School of Public Health. According to a statement released by President Obama, "Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower costs." The Senate Finance Committee will be responsible for Dr. Berwick's confirmation hearing. To date, a hearing has not been scheduled.

 

CMS Expected to Cover Newly-Approved Prostate Drug (June 2010)
The Centers for Medicare and Medicaid Services (CMS) is expected to cover a newly-approved prostate cancer drug that will cost approximately $93,000 for three infusions.

 

The new drug, Provenge, is designed to use a patient’s immune system to fight prostate cancer. According to a Food and Drug Administration press release, “The median survival for patients receiving Provenge treatments was 25.8 months as compared to 21.7 months for those who did not receive the new treatment.” Coverage for the drug will be provided under Medicare Part B. Medicare patients would still be required to cover 20 percent of the drug’s cost. You can read more about the FDA’s approval of Provenge at www.fda.gov.

 

House Approves Legislation to Repeal Antitrust Exemption for Insurers (April 2010)
The House approved the “Health Insurance Industry Fair Competition Act” (H.R. 4626) by a vote of 406-19 on February 24. The legislation would repeal the federal antitrust exemption enjoyed by health and medical liability insurers provided for under the McCarran-Ferguson Act. The legislation is intended to promote greater competition, support administrative simplification reforms and improve efficiency within the insurance industry. To date, the legislation has not been scheduled for consideration in the Senate.

 

State of the Union Speech Calls for Continued Healthcare Reform Efforts
(February 2010)
President Obama delivered his first official State of the Union speech before a joint session of Congress on January 27. While a large part of his speech addressed various components of the economy and efforts to create jobs, he did address the current state of the healthcare reform debate in Washington.

 

The President addressed the stalled negotiations and asked Congress to "take another look" at the proposals that have been advanced. He reiterated his belief that legislation is still needed and reaffirmed his position that individuals and families with existing insurance should be able to maintain their current coverage and still see their physician if they choose to do so. With respect to the troubled healthcare reform talks, the President concluded by saying, "If anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know...I am eager to see it."

 

It remains to be seen whether a compromise can be reached. The one thing that is almost certain is that it is highly unlikely that Congress will be able to send to the President’s desk a package as broad as those earlier approved by the House and Senate by narrow margins.

 

Massachusetts Special Election Changes Healthcare Reform Debate
(February 2010)
Republican Scott P. Brown's election to fill the US Senate seat vacated by Senator Edward M. Kennedy on January 19 changed the landscape of the healthcare reform debate, as well as the prospects for any legislation that is viewed to be controversial. As a result of Senator Brown's election, the Senate consists of 59 Democrats and 41 Republicans. Sixty votes are needed to end filibusters, which have become increasingly common. The change in the composition of the chamber will allow the minority to indefinitely delay floor action on any matter before the Senate. In the end, Senator Brown's election has called into doubt the enactment of a comprehensive healthcare reform package. The majority leadership in the House and Senate are left trying to find a way to move forward. It appears unlikely that a comprehensive healthcare reform bill will be sent to the President’s desk without considerable modification of the packages that have been advanced thus far.

 

Human Embryonic Stem Cell Lines Approved by the NIH (January 2010)
The National Institutes of Health (NIH) announced the approval of the first 13 human embryonic stem cell lines for use in federally-funded research on December 2. The final guidelines establishing the policy and procedures for federal funding of embryonic stem cell research was published on July 7 in the Federal Register and was in response to Executive Order (EO) 13505 entitled, "Removing Barriers to Responsible Scientific Research Involving Human Stem Cells." The EO removed an existing ban on federally-funded stem cell research put in place by the previous administration. According to a press release issued by the NIH, 11 of the approved lines were developed at the Children's Hospital Boston and two approved lines were developed at Rockefeller University in New York City. Additional embryonic stem cell lines are under review.

 

Funds Announced to Improve Community Health Centers (January 2010)
President Obama announced that $600 million in stimulus funds are being made available to fund Community Health Centers. According to the announcement, the funding will support health center construction, the adoption of health information technology systems and fund a medical home demonstration project to evaluate the benefits of the patient-centered medical home. In announcing the funding, President Obama said, "Taken together, these three initiatives won't just save money over the long term and create more jobs, they're also going to give more people the peace of mind of knowing that health care will be there for them and their families when they need it."