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Federal Affairs Network
(FAN) Meeting

June 16-17, 2009

The Madison Hotel
Washington, DC

Premier Advocacy held its June 2009 Federal Affairs Network (FAN) meeting in our nation’s capital on June 16-17. Premier’s Blair Childs and Margaret Reagan joined FAN Policy Committee Co-Chair Matt Williams, vice president of external relations for Catholic Healthcare Partners, in welcoming attendees and previewing the day’s events.

Premier FAN meetings, held in June and December of each year, provide government relations executives from alliance hospitals and health systems exclusive access to key policymakers on the federal front. FAN meetings feature discussions and presentations by federal healthcare veterans, Capitol Hill insiders and other health policy experts, and this year’s meeting could not have come at a better time for health reform. Throughout the meeting, attendees heard from the people directly involved in the debate some of what we can expect in the coming weeks and months, the issues likely to be raised, and the impact health reform will have on hospitals.

After sessions all Tuesday afternoon, attendees headed to Capitol Hill for a reception with Members and staff and then to a networking dinner at the Il Mulino restaurant. In between speakers on Wednesday, Premier’s Margaret Reagan, Linda Rouse and Sarah Wachtel recognized Peg McCormick Barron, vice president of legislative affairs for West Penn Allegheny Health System as the recipient of the Jim Scott Advocacy Award, which is presented each year to a Premier Federal Affairs Network member for his or her outstanding advocacy efforts.

Health Reform: The Public and Private Sector

Beth Fuchs, a lead healthcare policy analyst for Health Policy Alternatives, described the rapidly changing environment of healthcare reform.  She reviewed for the group the key elements of reform, which include coverage expansion, delivery system reforms and financing and the general approach that is taking shape among the healthcare reform proposals emerging out of congressional committees in each of these areas.  Fuchs focused on the policy issues revolving around expanding coverage, which include an individual mandate, an employer mandate, expansion of Medicaid and the Children’s Health Insurance Program (CHIP), private market insurance reforms, a health insurance exchange and public plan options.  Fuchs predicted that, while typically being skeptical of Congress’ ability to pass large reforms, the House and Senate will achieve healthcare reform, although perhaps not on the scale needed to achieve universal coverage.

Premier Update

Premier’s Blair Childs, senior vice president of public affairs, provided a summary of key accomplishments of the Premier advocacy office, as well as an update on the latest news in Washington, DC. Blair stressed key wins accomplished in 2008 and 2009, including the passage of comparative effectiveness research and health information technology implementation funds in the stimulus package and additional funds for hospitals through CHIP expansion as well as the prevention of key Medicare and Medicaid cuts; introduction of hospital value-based purchasing legislation consistent with the hospital community’s principles; and modifications to quality reporting measures and hospital-acquired condition requirements.

Blair then provided an update on the latest issues affecting members of the Premier alliance, including the Senate Finance Committee’s recent move to consider a proposal that would arbitrarily limit administrative fees. If included as a component of health reform or other legislation, this proposal could destroy Premier’s ability to effectively negotiate with manufacturers and pass savings back to the member hospitals. Blair urged hospitals to let members of the committee know that this concept would impede the goals of health reform to increase quality and contain costs.

Blair then discussed the latest activities within Premier, including updates on the future of the Hospital Quality Incentive Demonstration (HQID) project, which Premier is working to extend for another three years to test readmissions, bundled payments and other incentive mechanisms. He also discussed the latest results from the QUEST: High Performing Hospitals collaborative, which after just one year is already realizing significant improvements in the areas of cost, evidence-based care delivery and mortality. Lastly, Blair discussed Premier’s Perinatal Safety Initiative, which is improving hospitals’ compliance with recommended care bundles to eliminate preventable birth injuries.

Delivery System and Payment Reform

Danielle Lloyd, senior director of reimbursement policy at Premier, provided an overview of the various payment policies being considered in the health reform debate by the Senate Finance Committee and shared Premier's position on these issues.  Specifically, she covered value-based purchasing (VBP), readmissions policy, bundling payments and accountable care organizations (ACOs). 

The Finance Committee is considering VBP and readmissions policies that they project would result in savings for the federal government but proposes doing so in a way that would penalize a certain number of hospitals in order to obtain scorable savings.  Danielle explained that Premier has been working with Senate Finance Committee staff and urging them to revise the VBP policy so that among other things, it is budget neutral, allows for technical assistance to low performing hospitals serving vulnerable populations, and that any savings to Medicare be kept in the program. 

Danielle also expressed Premier’s view that while bundled payments hold promise for improving coordination of care, bundling should start under a voluntary pilot so models can be tested, common incentives must be implemented for physicians,  and rates should cover the costs of hiring "patient navigators" and other innovations.  Premier has similar positions regarding accountable care organizations (ACOs) in that physician and hospital payments should be aligned, it should begin with voluntary testing and it should include a broad array of organizational types to encourage the spread of ACOs. 

View from the Hill

During the View from the Hill discussion, Wendell Primus of Speaker Nancy Pelosi’s (D-CA) office outlined the Democratic priorities for health reform legislation, which are to reduce cost, improve quality and expand access to a larger number of Americans. Primus in particular discussed the need to address the cost of care across the country, which research has shown can vary by a ratio of up to three to one without any corresponding improvements in outcomes. Primus also stressed a need to more appropriately align incentives, and to bring physicians into the discussion, as differences in their treatment decisions are the root behind care variations across the country. Primus also discussed the timetable for legislation, and said he expected the House bills to be released this week and to move to the floor right before the August break.

Jacqueline Lampert of the Democratic Policy Committee echoed many of Primus’ thoughts, but specifically focused on the health reform timetable in the Senate. She discussed how the legislation being advanced is the byproduct of extensive meetings with stakeholders, all of whom were given an opportunity to voice their concerns throughout the process. Because of this, Lampert was confident that the Senate bills would be marked up in July. However, Lampert did acknowledge there are still significant areas still up for debate, including a range of options for how to best implement a public health insurance plan, whether to include an employer health insurance mandate and the financing of the proposed Health, Education, Labor and Pensions (HELP) legislation, which the Congressional Budget Office scored at $1 trillion.

Finally, Andy Chasin of the Republican Policy Committee acknowledged that Republicans are in favor of reform as a concept, but objected to the process, which he maintains has ignored all ideas put forward by his party. He also criticized the Democratic plan as providing “not enough bang for the buck” considering the CBO score and the estimate that only 16 million more Americans will have insurance under the HELP proposal. He urged Democrats to slow down in order to enact a package that is truly bipartisan, effective and put forward at a pace that allows Congress to fully understand what’s in the bill. Chasin also expressed strong objections to the public plan concept supported by Lampert and Primus, telling FAN members that if history is any precedent, the money to fund the plan will not be there, and the government will continue to cut reimbursements to providers in order to fund this giant bureaucracy.

Health Information Technology Implementation

Joe Lynch, a specialist in HIT for the law firm King and Spaulding, focused his presentation on the HIT issues immediately before hospitals and healthcare systems.  He reported that the HIT Policy Committee has released first recommendations toward a definition of “meaningful use” of HIT, and urged Premier members to submit comments relating to whether the standards would be possible to meet. 

Lynch underscored that an interim final rule will come out at the end of the year, but that it is not yet clear whether a proposed rule with a comment period will be released prior to this, indicating that this may be hospitals’ best opportunity to exert influence in this area.   He also suggested to hospitals that they will need to share information with their states to help them determine what level of Medicaid incentives they will be eligible to receive.  Finally, Lynch outlined important issues that hospitals should seek to address relating to what entities can quality for Medicare and Medicaid incentive payments. 

CMS Update

Jonathan Blum of the Centers for Medicare & Medicaid Services (CMS) spoke Wednesday morning and shared his thoughts on three main topics: the health reform agenda, payment priorities for CMS, and CMS management issues.  Regarding health reform, Blum stated that the administration continues to believe it should be budget neutral.  He also reiterated President Obama's preference that Congress lead on this issue and get a bill to him this fall. 

Medicare payment priorities are based on rethinking how the agency pays for care.  Blum stressed that CMS is open to all ideas to increase accountability and incentivize integration between doctors and hospitals.  CMS is willing to consider all options to attain these goals including bundling payments.  The main concern of CMS as it moves forward on regulations is to ensure that other provider payments don't create cliffs such as those currently occurring with the physician sustainable growth rate (SGR) payment formula.  Blum said CMS is very focused on getting documentation and coding changes correct in hospital payment regulations to avoid SGR-type payment cliffs.  Another priority for the agency on the regulatory front is getting competitive bidding implemented for durable medical equipment.  Blum also discussed the opportunity the doubling of the CMS demonstration budget (from $35 million to $70 million) provides in testing payment designs and to increase the coordination of care.

Rep. Earl Pomeroy (D-ND)

Representative Earl Pomeroy applauded Premier hospitals for banding together to get a “better deal” on healthcare while improving quality.   Pomeroy said there is a rapidly accelerating purpose in Congress in regard to healthcare reform and compared the types of reforms that are currently under consideration with the passage of legislation that established the Medicare program.  Pomeroy described the process the House and Senate are engaged in to accomplish reform, complimenting both his House colleagues and his Senate counterparts on their tremendous efforts.  

Pomeroy stressed that reforms cannot work if we fail to bring efficiencies into the system, stating that the phrase “If you pay for volume, you get volume,” perfectly describes the perverse incentives in the current system that need to be addressed.  He mentioned reforms that he believes will bring efficiencies and improved quality into the healthcare system, including: Accountable Care Organizations (ACOs), medical homes, expanding primary care, reducing hospital readmissions, bundling payments for acute and post-acute care, health information technology and reform of the Medicare physician payment’s SGR.  He indicated that he would be introducing the following day legislation to establish ACOs. 

Positioning Your Organization in the Health Reform Debate

Chris Hull, senior vice president at the public relations firm of Hill & Knowlton, began by describing the “uphill playing field” that providers must navigate in positioning themselves in the healthcare reform debate, showing the results of polls that say the public supports cutting Medicare payments to doctors and hospitals.  Hospitals’ primary objectives in improving their position should be driving public perceptions, attracting additional patients, improving financial position, increasing community clout, educating the public and policymakers about innovation, helping change the national policy debate, and fixing healthcare reform measures. 

Hull recommended some approaches to accomplish these goals, including: targeting federal policymakers; getting patients involved; putting a “face” on the story; building community coalitions, helping the media tell the tale; making the link with policy explicit; and sharing these efforts with Premier.  For local media to cover hospitals’ positions on national policy a story, Hull suggested that hospitals release press statements describing how the policy would impact the local community and provide an individual patient story, whenever possible.  In developing messages, Hull suggested to the group that they identify the strengths, weaknesses, opportunities and threats in every situation to prepare for how the media and public may respond. 

In closing, Hull walked through examples of several initiatives to illustrate how hospitals could better position themselves to influence the healthcare policy debate. Hull said that rather than press clip counts, the metric that hospitals and health systems should use to measure their success in getting out their message is the impact they are able to have in healthcare legislation.

Save the date—Next FAN meeting set for Dec. 7-8

Mark your calendars now! The next FAN meeting is scheduled for Dec. 7-8, 2009 at the historic Hay-Adams hotel in downtown Washington, D.C. A favorite venue for our FAN meeting, the Hay-Adams is blocks from the White House and a short cab ride to Capitol Hill. Make your plans to attend. More information on hotel and meeting registration to come!

 

 

 

 

 

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