Topics this week:
- Update on ‘Fiscal Cliff’ negotiations
- VA Lifts Restrictions on Veterans with Brain Injuries
- Scrutiny of Compounding Pharmacies increases
- Health Policy 101: 'Meaningful Use' and the Electronic Medical Record
1. Update on ‘Fiscal Cliff’ Negotiations
Negotiations have continued this week to avoid the ‘fiscal cliff,’ the automatic spending cuts and tax hikes that will happen in January unless the President & Congress can agree on a way to stop them. In recent news, House Speaker John Boehner (R-Ohio) rejected the plan set forth by Treasury Secretary Timothy Geithner. Geithner’s plan included $1.6 trillion in tax increases and $400 billion in savings from Medicare & social programs over the next 10 years. Democrats have now called on the Republicans to come up with a plan.
The largest point of contention thus far has been the ending Bush Tax cuts for the wealthiest 2% of Americans. Boehner has been opposed to this tax increase thus far, but many Republicans are calling for a concession on this point so that they can bargain in return for changes to social programs such as Medicare. Some options being discussed are to raise the Medicare eligibility age to 67 (instead of 65), charge wealthier patients more for their coverage, or pay providers less. While increasing the age of Medicare could save the government over $100 billion, opponents argue that much of that cost would be shifted to employers and the elderly instead.
If no agreement can be reached, the sequestration of Medicare would result in a 2% payment cut to providers, the burden of which would largely fall on hospitals. This is in addition to the 27% cut to Medicare providers that is already scheduled to occur as a result of the Sustainable Growth Rate (SGR). Other significant cuts affecting the medical community include cuts to the NIH of $2.5 billion in 2013. The CDC and FDA also face cuts.
Sources:
Kaiser Health News
Kaiser Health News on the Fiscal Cliff
AAMC Advocacy Page
Bloomberg.com
2. VA Lifts Restrictions on Veterans with Brain Injuries
More than 250,000 service members have been diagnosed with traumatic brain injury (TBI) since 2000, but only 51,000 of them are receiving benefits for these injuries. Currently veterans must provide evidence that their TBI is the direct result of military service. New regulations were published today, and list Parkinsonism, seizures, dementia, depression, and hormone deficiencies as eligible for expanded benefits. Veterans will still have to prove that a TBI was caused by their service in the military, but after that has been established the five aforementioned diseases will be attributed to the TBI without further documentation necessary. Additionally, most of these diseases are only covered if the TBI was moderate or severe (only 20% of TBI cases). There are also other criteria for coverage, such as time windows in which the disease must present after TBI, but the hope is that this new rule will expedite and simplify these cases. Veterans may begin submitting claims after a 60-day public comment period.
Sources:
Nytimes.com
3. Scrutiny of Compounding Pharmacies Increases as Meningitis Outbreak Continues
In light of a recent fungal meningitis outbreak that killed 36 people and sickened more than 500 in 23 states, Congress is investigating the International Academy of Compounding Pharmacists. This outbreak of meningitis has been linked to contaminated steroid injections in New England that were produced by compounding pharmacies – pharmacies that mix customized medications for patients. Inspections of all compounding pharmacies in Massachusetts are being conducted, and thus far three pharmacies have been closed due to discovery of inappropriate storage or preparation of drugs. In addition to the contaminated steroids, the inspectors have placed cease & desist restrictions pharmacies for their production of chemotherapy and Viagra.
The House Committee on Energy & Commerce is investigating the International Academy of Compounding Pharmacists to determine if the organization encouraged pharmacists to ‘impede the FDA from evaluating the efficacy and safety of their products.’ There has also been an increased push to give the FDA a greater role in regulating these pharmacies, which are currently under oversight by state pharmacy boards.
Sources:
Bostonglobe.com
Usatoday.com
4. Health Policy 101: Meaningful Use & The Electronic Medical Record (EMR)
What is ‘Meaningful Use’?
Through the Health Information Technology for Economic and Clinical Health Act (HITECH) passed in 2009, the Center for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) defined a set of standards that would govern the use of EMRs. It was decided that simply having an EMR was not sufficient, but that hospitals must make ‘meaningful use’ of these EMRs in a way to improve the health care system. The goal is to allow easier communication of a patient’s medical record between physicians and also to serve as a source for quality improvement data.
In May 2011, the government began paying bonuses to hospitals and clinicians that used EMRs, with individual doctors earning up to $44,000 and hospitals earning millions if they demonstrate ‘meaningful use’. These bonuses are designed to offset the cost of implementing EMRs. Providers must prove that they have met Stage 1 criteria (see below) by 2015, or else they face a 1% cut to Medicare Part B payment.
There are 3 stages of requirements that must be met in order to receive the bonuses. We are currently in Stage 1, which focuses on data capturing & sharing. Stage 2 occurs in 2014 and will be more focused on advancing clinical processes, and in 2016 Stage 3 will focus on improved outcomes. Each stage has a set of criteria that must be met.
To meet the Meaningful-Use criteria for Stage 1, more than 80% of patients must have records in an EMR, and physicians and hospitals must report on 20 of 25 criteria (15 required core objectives plus 5/10 additional objectives, with slightly different options for hospitals & individual clinicians). Core objectives include things like recording demographics, vitals, problem lists, medication lists, medication allergies, e-Prescribing, drug-drug and drug-allergy interactions, and reporting on clinical quality. Additional hospital objectives include having computerized physician order entry, reporting quality measures to CMS or states, and recording advanced directives. For the full list: http://www.nejm.org/doi/full/10.1056/NEJMp1006114
How is it going so far?
A recent CDC National Center for Health Statistics Report found that 72% of office-based physicians use some form of EMR (up from 48% in 2009). Two thirds of office-based physicians have applied or were planning to apply for meaningful use incentives by the Nov 30, 2012 deadline, but only 25% actually have adequate computer systems.
A report released by the Department of Health & Human Services (HHS) last month found that CMS is having difficulty overseeing the incentive program. Currently the CMS uses a self-report system to determine if a hospital or clinician meets the meaningful use criteria, and there is no verification of the information prior to payment. As a result of this report, HHS made recommendations to CMS to collect supporting documentation to verify the self-report information, but the CMS has disagreed with this recommendation.
While the Nov 30 deadline for hospitals and physicians to attest that they have met Stage 1 meaningful use criteria has passed, an extension was granted to hospitals in New York and New Jersey that were adversely affected by Hurricane Sandy. These hospitals will now have until the spring of 2013 to submit their attestation.
Sources:
AAMC Advocacy
Robert Wood Johnson Foundation
AAMC Update on Hurricane Sandy
Medpagetoday.com
Your loyal Legislative Affairs team,
Brad Hunter – Northeast Region
Robert Sanchez – Central Region
Sean Vanlandingham – Southern Region
Claire Sadler – Western Region
William Teeter – National Delegate
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To access previous updates see our blog at:
https://www.aamc.org/members/osr/communications/legislative_affairs/
For more Health Care Policy news go to:
https://www.aamc.org/members/osr/communications/legislative_affairs/49198/legislative_affairs_resources.html