Paul's Message
ASN Members:
2004 is shaping up to be an extremely busy year for the American Society of Nephrology (ASN) in the area of Policy and Public Affairs. While NIH funding and CMS reimbursement issues top the agenda, I will look forward to working with the ASN Council, Policy and Public Affairs Committee, Board of Advisors, and a multitude of other renal organizations to ensure that ASN members are well-represented on a range of issues on the policy front.
This edition of Renal Policy Express will highlight a number of different issues currently affecting you. One issue, which affects a large fraction of our members, is the recent revision of reimbursement for physicians caring for outpatient dialysis patients. I encourage you to read ASN's formal response to CMS and Dr. Mitch's subsequent memo to the ASN membership to provide you with more information on the issue. The attached document will also answer questions you may have on the new G-Codes, due to changes in the 2004 Physician Fee Schedule Rule.
Another important step in ASN's policy efforts is that we recently joined other major health organizations in an effort to fight threatening budget shortfalls in critical health programs and to make funding for our nation's health programs a top priority for federal policymakers. The campaign, launched in January 2004, seeks to increase the Fiscal Year (FY) 2005 budget allocation for health programs, known as Function 550. Programs in Function 550 are directed by federal agencies and dedicated to preventing disease, advancing medical knowledge, delivering key health care services, ensuring food safety, and training a diverse health and public health workforce.
The goal of the campaign is to develop a single, unified message that organizations can deliver to Capitol Hill. Working with the Coalition for Health Funding, it was determined that a 12% increase in Function 550 is necessary for FY 2005 to adequately fund critical health programs and improve the health, safety, and security of the nation. Since joining the campaign, ASN recently signed on to a letter to Congress and the President that calls for the 12% increase in Function 550. Over 230 organizations have signed on to this letter.
In the era of tight federal budgets, ASN recognizes the need to convince policymakers to increase the allocation for Function 550 in the Federal Budget. Otherwise, FY 2005 budget allocations will leave congressional appropriators limited options to fund critical bio-medical research at the National Institutes of Health (NIH) which lead to scientific discovery and improves the health of the nation particularly for those individuals with chronic diseases such as kidney disease. ASN is also concerned about funding for programs that seek to eliminate health disparities that disproportionately impact certain racial, ethnic and rural populations which have a higher rate of kidney disease and work force initiatives that recruit, retain, and train researchers, scientists and health professional and practitioners.
The health of all Americans is at risk from an unprecedented range of threats, including: chronic diseases, a shortage of healthcare providers and trained public health workers. Our nation's public health system will not be able to respond adequately to these threats and kidney disease without additional resources for the continuum of medical research, prevention, treatment, and training programs.
Sincerely yours,
Paul C. Smedberg
Director, Policy and Public Affairs
FY 2004 Federal Funding Finalized
By a close vote, the U. S. Senate passed the “Consolidated Appropriations Act” (H.R. 2673) which combined seven of the thirteen federal appropriations bills for fiscal year (FY) 2004. The legislation, which passed the House of Representatives in December 2003, is expected to be signed by the President.
ASN joined with the health community to strongly urge the Senate to adopt the conference report accompanying the Consolidated Appropriations Act, which included funding for the
National Institutes of Health (NIH).
Click here to read the letter.
Despite the disappointing final result for NIH in the conference agreement, the ASN believed it was important that the health community support passage of the measure to provide the additional funds to NIH because the alternative to passage of the omnibus could be a year-long Continuing Resolution at FY 2003 levels. For NIH, the conference report includes $27.983 billion, an increase of $1 billion (3.7%) over FY 2003. However, the conference report also requires a 0.59 % across-the-board cut, which reduces the NIH budget to $27.818 billion, an increase of $835 million (3.1%). This amount will be reduced further by the transfer of $150 million from the NIH for the Global HIV/AIDS fund and a 2.2% departmental evaluation transfer "tap".
Adequate funding for the NIH and specifically for the National Institutes for Diseases & Digestive & Kidney Diseases (NIDDK) is a key policy priority for the Society. NIH funding in Fiscal Year (FY) 2005 is critical in light of the 3.1 percent increase in NIH funding for FY 2004.
Key Health Agency Funding Levels FY 2004:
National Institutes of Health
FY 2004 Funding $27.8 billion
FY 2003 Funding $27.0 billion
Agency for Healthcare Research & Quality
FY 2004 Funding $303.7 million
FY 2003 Funding $303.7 million
Department of Veterans Affairs Health Research Program
FY 2004 Funding $408.0 million
FY 2003 Funding $397.0 million
Congress Investigates Alleged Conflict of Interest at NIH
There is mounting congressional concern over the current NIH policies regarding conflict of interests. On January 22, the Senate Labor, HHS Appropriations Subcommittee convened a hearing focused on the financial arrangements between NIH investigators and corporate entities for expert advice and lecture awards. Senators Arlen Specter (R-PA) and Tom Harkin (D-IA) both of whom are Senate champions of NIH funding, led the hearing and expressed grave concerns over the allegations.
Elias Zerhouni, M.D., NIH Director stated, at the hearing that he would address the growing number of collaborations between NIH scientists and private companies and the implications of those arrangements. The collaborations have been explicitly encouraged by Congress since the 1980s to speed translation of federally funded research into medical products. Current rules require collaborators to work on such projects on personal time and submit papers to federal ethics officers to ensure they do not pose a conflict of interest. One problem Dr. Zerhouni and the NIH Directors must address is the growing complexity of corporate relationships because they and federal ethics officers might not realize that these companies may own or control other companies or research groups that are competing for NIH grants those directors oversee.
During his testimony, Dr. Zerhouni announced the formation of a blue-ribbon panel to examine the allegations. Norman Augustine, Chair of the Executive Committee of Lockheed Martin and Bruce Alberts, Ph.D., President of the National Academy of Sciences will co-chair the panel. The NIH took additional steps by establishing an NIH Ethics Advisory Panel to oversee consulting arrangements and began an agency-wide effort to collect and review all instances of NIH employees receiving compensation from corporate entities since January 1, 1999.
Members of the House of Representatives requested a General Accounting Office investigation of consulting fees and stock options paid to NIH employees. Several members of Congress have recently questioned the ability of NIH to justify the appropriateness of some NIH-funded studies and ability to manage its budget which has doubled in five years.
ASN Joins Ad-Hoc Group For Medical Research Executive Committee
Paul Smedberg recently became a member of the Executive Committee of the Ad-Hoc Group for Medical Research Funding, joining 20 other leading medical and scientific organizations on the executive committee, including the Association of American Medical Colleges, Research!America, FASEB, American Heart Association and the American Academy of Pediatrics.
The executive committee develops NIH funding proposals, participates in annual meetings with the NIH Director and Institute directors, organizes policy briefings for key congressional and committee staff and develops, coordinates, and implements the Group's advocacy strategies. ASN's participation on the committee will also provide the opportunity to highlight kidney disease research.
The Ad-Hoc Group's mission is to enhance the federal investment in biomedical, behavioral, and population-based research by increasing the funding for the NIH. The Ad-Hoc Group is a coalition of more than 300 patient and voluntary health organizations, medical and scientific societies, academic research organizations and business and industry groups.
Dennis Smith Selected As Interim Head for CMS
HHS Secretary Tommy G. Thompson today named Dennis G. Smith as interim head of the Centers for Medicare & Medicaid Services (CMS). Smith becomes Acting Administrator following the recent resignation of CMS Administrator Tom Scully. Prior to his appointment, Smith was Director of CMS' Center for Medicaid and State Operations.
With an estimated FY 2004 budget of almost a half trillion dollars ($495 billion in budget authority), CMS' Medicare and Medicaid are the second and third largest federal programs, behind the Social Security Administration, in total budget.
CMS Revises 2004 Physician Fee Schedule in Final Rule
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on January 6, 2004 to revise the physician fee schedule. The rule implements an increase of 1.5 percent in the fee schedule reversing a scheduled 4.5 percent decrease. The final rule is mandated by the Medicare Prescription Drug Modernization Act signed into law by President Bush.
Future Meetings
February 9, 2004 - The ASN will attend the next Friends of the Agency for Healthcare Research & Quality (AHRQ) meeting. Dr. Carolyn Clancy, AHRQ Administrator, will present the Administration's proposed FY05 budget and agency priorities. Directly following, attendees will discuss the political strategy in support of AHRQ for the coming year.
February 2004 - Dr. Karen Campbell, ASN's Executive Director, and Paul Smedberg will attend the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) Coordinating Panel Meeting at the National Institutes of Health (NIH). The Panel meets yearly to learn about clearinghouse programs, provide guidance for upcoming projects, share news about the activities of each other's organizations, and network with one another regarding issues concerning kidney and urologic diseases.
March 22 – 24, 2004 – The ASN will attend the Centers for Medicare and Medicaid (CMS) Forum of ESRD Networks' Stakeholders Annual Meeting. The theme of the meeting is ‘Collaborating to Improve Care: Everyone Counts.' Agenda items include Medicare's Dialysis Facility Compare Website and plans for developing a hemodialysis patients' experience of care (CAHPS) survey.
