WASHINGTON WIRE

Jan 25, 2010

Issue 228

In this issue, you'll find:

Massachusetts Special Election Race Affects Fate of Healthcare Reform

Before Massachusetts Special Election, Democratic Leaders Worked out Healthcare Compromises
Exemption to Pay-Go Rules for Doc Fix Could Get Tacked Onto Debt Measure
MedPAC Holds January Meeting to Discuss Payment Recommendations
FDA Released Recommendations on Radiation Exposure from CT Scans
CMS to Test EHRs for Submmission of Inpatient Quality Measures Data

Hearings

Top Story

Massachusetts Special Election Race Affects Fate of Healthcare Reform

In the wake of last Tuesday's Massachusetts special election results, Democratic Congressional leaders and the White House are deliberating the next steps for healthcare reform legislation. Republican candidate Scott Brown beat Democratic candidate Martha Coakley, delivering a stinging loss to Democrats who until then held a supermajority in the Senate. Plans to send a revised version of the healthcare bill for further votes have come to a screeching halt, as it is not expected that with the seating of Brown, Democrats would be able to avoid a filibuster in the Senate.

Congressional leaders and the White House are working on back-up plans, including one plan that would involve the House passing the Senate version of the bill, avoiding the need to send the comprehensive legislation back to the upper chamber. House lawmakers that object to a number of the provisions in the Senate's current version could hypothetically alter the larger bill through separate legislation that could be passed in the Senate through the reconciliation process, which would require only a simple majority.

But a Republican win in the liberal state of Massachusetts has rattled some House Democrats enough for them to express doubts about supporting the Senate bill, especially if not passed simultaneously with a reconciliation package. The press is reporting that another back up plan would consist of a pared down package to be passed and sent to the President's desk. But this bill would still need to survive votes in both chambers.

Health Care News

Before Massachusetts Special Election, Democratic Leaders Worked out Healthcare Compromises

Before the results of the Massachusetts special election put the fate of healthcare reform legislation in jeopardy, Congressional Democratic leaders and the White House were working on a series of compromises for the major differences between the Senate and House healthcare bills.

There are a number of controversial and significant differences between the two bills that leaders have attempted to iron out. One of the most recent compromise involves an agreement between the White House and union leaders over the excise tax on high cost insurance plans. The threshold used to mark the line for high cost or "Cadillac" plans would be increased by $1000 to a total of $24,000 for a family and increased $400 for individuals, pushing their threshold to $8,900. Dental and vision plans would be excluded from the threshold estimate. The excise tax would not go into effect until 2018 for state and local plans, as well as workers subject to collective bargaining agreements. The tax would go into effect in 2013 for most other plans.

Republicans have seized upon the compromise with unions as an example of closed door negotiations that have been a hallmark of the informal conference process. Besides the excise tax on high cost plans, lawmakers were working to find compromises on abortion language, health insurance exchanges and other issues.

Exemption to Pay-Go Rules for Doc Fix Could Get Tacked Onto Debt Measure

It is rumored that a five year exemption of the pay-go rules for the physician fee fix could be attached to a debt limit measure that Congress will vote on soon. Last December, Congress passed a short-term increase of the debt limit set to expire in February. The current measure, which would increase the debt ceiling by about $1.9 trillion, is unpopular with centrist and vulnerable lawmakers facing tough reelections in November. To make the measure more politically palatable, there is talk of tacking onto it a special commission to reduce the nation’s debt.

And recently the press began reporting that the limit could also address the pending 21.2 percent cut to Medicare physician payments. The debt ceiling measure could include a five-year waiver of the pay-as-you-go rules for the doc fix.

Moderates in the Senate are applying press for the Congress to create an independent budget commission to develop a plan to reduce spending and decrease the nation's debt. If passed, the amendment to the debt limit measure would create a bipartisan commission composed of lawmakers and administration officials that would propose debt and deficit reduction policies that could touch on any aspect of the budget and tax code. 

MedPAC Holds January Meeting to Discuss Payment Recommendations

On January 14 and 15, the Medicare Payment Advisory Commission (MedPAC) held a session regarding payment adequacy across a number of provider groups. MedPAC recommended that Congress give hospitals a fiscal year 2011 payment update equal to the rate of change in the market basket index, currently projected at 2.4%, concurrent with implementation of a pay-for-performance program. However, the commission also recommended HHS reduce the inpatient update by up to 2% in 2011, 2012 and 2013, which would result in an inpatient update of 0.4% in FY 2011.

MedPAC also recommended Congress provide no payment update in fiscal year 2011 for inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities or home health providers. For hospice providers, the commission recommended that Congress provide a 2011 payment update of market basket minus productivity.
MedPAC estimates that this will result in a 1.1% increase in payment for hospice providers in 2011.

During the physician services meeting, the MedPAC Commission forwarded its recommendation that Congress should update payments for physicians in 2011 by 1%.

FDA Released Recommendations on Radiation Exposure from CT Scans

The Food and Drug Administration recently released interim recommendations to imaging facilities, radiologists and radiologic technologists regarding exposure to radiation during CT perfusion imaging of the brain. The recommendations are part of an ongoing investigation into cases of excess radiation during the imaging procedure; the agency has identified patients in Los Angeles and Alabama who had been exposed to excess radiation during the scans. Some of the patients were exposed to excess radiation of up to eight times the expected level.
The interim recommendations apply to all CT perfusion images, including brain and heart, and include recommendations that:

• Facilities assess whether patients who underwent CT perfusion scans received excess radiation.
• Facilities review their radiation dosing protocols for all CT perfusion studies to ensure that the correct dosing is planned for each study.
• Facilities implement quality control procedures to ensure that dosing protocols are followed every time and the planned amount of radiation is administered.
• Radiologic technologists check the CT scanner display panel before performing a study to make sure the amount of radiation to be delivered is at the appropriate level for the individual patient. 
  

CMS to Test EHRs for Submission of Inpatient Quality Measures Data

Earlier this month, CMS announced an initiative to test the ability of participating hospitals' electronic health record (EHR) ability to submit inpatient quality data and the agency's technical ability to accept data from those EHR systems on quality measurement topics pertaining to emergency department throughput, stroke, and venous thromboembolism. CMS will use the results to assess the feasibility of collecting data elements for inpatient measures via electronic health records instead of relying on manually abstracted chart data elements by hospitals. EHR vendors and hospitals that want to participate in the testing process must self-nominate by sending CMS a letter of interest by February 1.

Upcoming Events

Hearings

No healthcare hearings are yet scheduled for this week.

For More Information

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