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Washington Outlook

April 3, 2009

House and Senate approve FY 2010 budget resolution with healthcare reserve fund

Both the House and the Senate approved separate versions of a $3.5 trillion fiscal year 2010 budget resolution this week. Both versions contain a budget-neutral reserve fund for healthcare reform, in line with President Obama’s aggressive agenda for spending set forth in his budget outline released last month.  The resolutions leave the details of healthcare reform to key healthcare authorizing committees, which have been grappling with the best approach through a series of hearings and negotiations with House and Senate leaders, as well as the White House.

The two chambers now must iron out the differences between their budget blueprints after Congress reconvenes the week of April 20, following the congressional spring recess.  The major sticking point will be reaching agreement on whether to include reconciliation instructions—which the House resolution includes and the Senate version does not—that would allow healthcare legislation to pass the Senate by a simple majority, rather than usual 60 votes needed.

The House passed its resolution by a vote of 233-196, with 20 Democrats joining Republicans in voting against the bill, after rejecting four alternatives.  The Senate approved its version by a vote of 55-43, with all Republicans and two Democrats voting in opposition.

During debate of its budget resolution, the Senate rejected an amendment offered by Senator Jon Kyl (R-AZ) that would have prohibited coverage denials under federal healthcare programs based on data from comparative effectiveness research, which received $1.1 billion in funding through the American Recovery and Reinvestment Act (ARRA).   The amendment was defeated by a vote of 54-44.  Language in the conference report accompanying ARRA conveys Congress’ intent that comparative research should not be used to make coverage determinations, but the law does not explicitly contain such a ban. Senate Finance Committee Chairman Max Baucus (D-MT) said that he was working with Ranking Member Charles Grassley (R-IA) and Senate Health, Labor, Education and Pensions Committee Ranking Member Mike Enzi (R-WY) on a bill that would ensure comparative effectiveness research focuses on quality, not cost.

The Senate also debated and adopted an amendment by unanimous consent that would establish another deficit-neutral reserve fund to address healthcare access problems in rural areas caused by inadequate Medicare and Medicaid payments.

North Shore LIJ Health System testifies before House Ways and Means Committee on experience in CMS/Premier pay-for-performance project

Dr. Lawrence Smith, chief medical officer of North Shore LIJ Health System, testified on behalf of both his healthcare system and Premier at this Wednesday’s House Ways and Means Committee hearing on "Health Reform in the 21st Century: Reforming the Health Care Delivery System." 

Also testifying at the hearing were Dr. Glenn Steele, president and CEO of Premier member Geisinger Health System and Dr. L. Allen Dobson Jr., vice president for clinical practice development at Carolinas Health System, also a Premier member.  Other witnesses included Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission; and Dr. Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice, among others.  

Dr. Smith's testimony focused on lessons learned through Northshore-LIJ's continued participation in the Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project since 2003 and the impact it has had on quality improvement at the system's 14 hospitals. He also underscored the importance of including in health reform legislation measures to align all participants in the delivery of care through coordination, integration and stakeholder involvement.

Leaders of congressional committees with jurisdiction over healthcare have indicated that reform legislation may be drafted as early as this summer. This was the second in a series of Ways and Means hearings on the issue; a March hearing focused on access, quality and cost reduction. Members at this week’s hearing expressed interest in further examining the issue of quality improvement through programs such as HQID as they craft health reform legislation.  

Dr. Smith's testimony and slides are available on Premier's Web site. Other hearing documents are available on the Ways and Means Committee Web site.

Over the last two weeks, the House Energy and Commerce Committee has maintained an aggressive hearing schedule focused on healthcare reform, holding three hearings that are part of a series entitled “Making Health Care Work for American Families.”  In the other chamber, the Senate Health, Education, Labor and Pensions Committee held a March 24 roundtable hearing to discuss potential changes to the private health insurance market and the Senate Finance Committee focused on the role of long-term care in healthcare reform during a March 31 hearing

Premier commends Rep. Altmire for introducing hospital value-based purchasing bill

Premier expressed appreciation for Representative Jason Altmire’s (D-PA) leadership in advancing the healthcare quality agenda by introducing the “Quality First Act of 2009,” (H.R. 1776), which would implement hospital value-based purchasing on a national scale in the Medicare program.  In an April 3 letter, Premier Senior Vice President of Public Affairs, Blair Childs, thanked Altmire for incorporating in the legislation the lessons garnered from the CMS/Premier Hospital Quality Incentive Demonstration (HQID), a project designed to test whether financial incentives, coupled with transparency, result in hospital quality improvement.  
Childs pointed out in the letter several key provisions that Premier supports, including basing payments on performance of evidence-driven and consensus-based quality measures, rewarding hospitals for both attainment of a reasonable benchmark and improvement and requiring an actuarial analysis of the cost reducing impact of improvements so that savings can be shared with hospitals.
“These provisions are consistent with the principles developed by the hospital industry, creating positive incentives while also incentivizing higher performance,” said Childs.
In seeking House cosponsors of the Quality First Act, Altmire said, “Unlike other reform
proposals that require the federal government to either spend more or cut back on patient services, hospital value-based purchasing would move our health care system in the right direction by both improving the quality of patient and reducing its overall cost.”
Rep. Altmire’s overview of the Quality First Act is available on Premier Advocacy Web site.

House Appropriations Committee addresses healthcare-associated infections

The House Labor-HHS-Education Appropriations Subcommittee focused on federal and state efforts to reduce healthcare associated infections (HAIs) during an April 1 hearing entitled “National Strategy to Reduce Healthcare-Associated Infections.”  Committee members heard from Department of Health and Human Services (HHS) officials on how their agencies are using funding from the American Recovery and Reinvestment Act to address HAIs.

Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), outlined her agency’s efforts to address HAIs, specifically the research AHRQ has been conducting with 34 hospitals to look at barriers to reducing HAIs. This research will be used to develop a tool kit for other hospitals based on the lessons learned.  Clancy also highlighted the AHRQ-funded Keystone Project that has been successful in reducing central line bloodstream infections. Keystone has been so successful that it has been expanded to 10 states, with future plans calling for the program to reach an additional 20 states. 

Acting director of the Centers for Disease Control and Prevention (CDC), Richard Besser, highlighted the CDC’s activities and the partners with which it is collaborating in this area, particularly the new inter-agency steering committee established by HHS to implement its national action plan to significantly reduce HAIs within five years.  Besser indicated that the CDC will allocate $40 million of the $50 million included in the stimulus law for state HAI reduction efforts and will focus on the following three priorities: 

HHS Principal Deputy Assistant Secretary Don Wright discussed the work of the department on creating a national HAI reduction plan, stating that the agency is currently reviewing all comments it received on the plan, will hold several stakeholder meetings beginning this spring and will be updating the plan in response to the public input.

President restricts lobbying for stimulus funds

President Obama issued on March 20 a memorandum instructing heads of the executive departments and federal agencies to ensure that public funds contained in the ARRA are spent in a responsible and transparent manner.   Specifically, the communication outlined a policy that restricts registered lobbyists from attending meetings or holding telephone conversations when a specific project or funding plan under the ARRA is being discussed.  Instead, registered lobbyists can submit questions or comments on an ARRA-related matter in writing, which will be posted on the agency's Web site.  Oral conversations about general ARRA issues are permitted as long as they are documented by the government official.
The Office of Management and Budget is required to issue further guidance to agency executives and within 60 days suggest any possible modifications and revisions to the new policy.

Weekly legislative and regulatory round-up

The round-up for the week of March 28 - April 3 is available here.

The round-up for the week of March 21 - 27 is available here.