Paul's Message
Dear ASN Members:
The ASN Policy & Public Committee is currently seeking new members to help advance the Society's expanding research and regulatory affairs agenda.
Much of the work of ASN is accomplished through the energetic activity and input of committees, so this is a great way for you to influence the effectiveness and quality of membership services offered to ASN members.
Policy & Public Affairs Committee members will play a key role in formulating policy positions and guiding initiatives targeted at the National Institutes of Health, Centers of Medicare and Medicaid Funding, and Congress. ASN members interested in joining the Committee or in nominating someone for the Committee should email me a letter of interest or a nomination letter and indicate a preference for the research or regulatory affairs subcommittee. If you have questions about the Committee, please contact me by telephone at 202-416-0646 or email me.
The American Society of Nephrology (ASN) joined 275 organizations in urging House and Senate leadership and Republican and Democratic Appropriations Committee leadership to provide the highest possible allocation for the Labor, Health and Human Services and Education Appropriations Subcommittee, when the Appropriations Committee meets to determine the 302b allocations for the various subcommittees. While we understand that Congress must make tough decisions in the face of a growing deficit, protecting and improving the health of the nation must be a top priority. In January 2004, the ASN joined with 400 other health organizations in calling for a $6.1 billion (12%) increase in the budget for discretionary health programs. Read the letter.
We are very concerned that the pending budget proposal for fiscal year 2005 fails to provide adequate funding for critical public health programs - especially for the National Institutes of Health, at a time when our nation faces an unprecedented range of health threats from chronic diseases and disabilities to biological and chemical terrorism to a shortage of healthcare providers and trained public health workers. Our nation's public health system will not be able to respond to these threats without additional resources for the continuum of medical research, prevention, treatment, and training programs. The ASN has also signed letters supporting biomedical and health research funding at the Department of Veterans Affairs and the Agency for Healthcare Research & Quality.
Paul C. Smedberg
Director, Policy and Public Affairs
Budget Resolution Falls Off Congressional Calendar
Senate Majority Leader Bill Frist, (R-TN), laid out a pared-down agenda for now through the Memorial Day recess. Notably absent was a final version of the fiscal 2005 budget resolution (Senate Conference Resolution 95), which has stalled in a House-Senate dispute over offset requirements for tax cuts. If negotiations between House and Senate members do not produce a compromise on tax cut offsets, then appropriations bills can move forward under a deeming resolution. Normally the deeming resolution uses the last passed budget for its target discretionary number, which in this case would be $814 billion -- fully $7 billion below the $821 billion in the FY 2005 budget resolution conference. Recently, House Appropriations Chairman, Bill Young (R-FL) has made 302b allocations to the Subcommittee's so that they can begin work on their respective FY 2005 bills while negotiations continue on the budget resolution. For the House Labor-HHS-Education Subcommittee, the working allocation is $142.5 billion, up slightly from the FY 2004 enacted level of $139, after the .59 across-the-board cut.
NIH Releases Blue Ribbon Report
The NIH Blue Ribbon Panel on Conflict of Interest Policies released its report on May 5, 2004. Elias Zerhouni, M.D., NIH Director established the panel to address the growing number of collaborations between NIH scientists and private companies and to discuss the implications of these agreements. The collaborations have been explicitly encouraged by Congress since the 1980s to speed translation of federally funded research into medical products. One issue Dr. Zerhouni and the NIH directors asked the panel to 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 the directors oversee.
Early in the year, congressional concern began to mount over the current NIH policies regarding conflict of interest. Additionally, members of the House 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. The report of the NIH Blue Ribbon Panel on Conflict of Interest Policies is available here.
CMS Issues ESRD CPM Annual Report
The Centers for Medicare and Medicaid Services (CMS) released the 2003 ESRD Clinical Performance Measures (CPM) Annual Report, which was later posted to their website. This Report presents findings from the most recent data collection of the CPMs in the areas of dialysis adequacy, anemia management, vascular access (for hemodialysis patients only), and nutrition. For the pediatric and adult in-center hemodialysis patients, the data is from October-December 2002; for the adult peritoneal dialysis patients, the data is from October 2002-March 2003. Hardcopies of this report were printed and mailed to all facilities in late April 2004.
The Council of American Kidney Societies (CAKS) Annual Meeting will take place in Washington, DC June 6-7, 2004. CAKS members will meet with NIH and Administration officials to discuss kidney research initiatives and renal regulatory issues. CAKS members will also discuss coordinated public policy initiatives.
Move Toward Electronic Medical Records
President Bush set the goal of creating electronic medical records within the next 10 years and announced that he will create a new, sub-Cabinet level position called "National Health Information Technology Coordinator" in an April 26 speech focused on promoting innovation. "Within 10 years, every American must have a personal electronic medical record. That's a good goal for the country to achieve," Bush said in a speech to the American Association of Community Colleges at their Annual Convention in Minneapolis.
The Health Information Technology Coordinator will report directly to the Secretary of Health and Human Services (HHS), guide ongoing work on health information standards, and implement steps to encourage health information technology in public and private healthcare delivery systems. The Administration also said that President Bush will direct federal agencies and federal health programs, like Medicare and Medicaid, to create incentives for healthcare providers to use electronic records.
Medicare Drug Discount Card
CMS has started to ask healthcare providers to refer Medicare members to Medicare's telephone helpline (1-800-Medicare) or website to learn about the new Medicare drug discount card. Medicare physicians, providers, and pharmacy professionals are invited to visit the CMS website to download informational materials addressing the Medicare-Approved Drug Discount Cards and Transitional Assistance Program and to get further information on other Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) provisions. Congress mandated the Medicare-Approved Drug Discount Cards and Transitional Assistance Program through the MMA. CMS has prepared a variety of educational products to assist providers, beneficiaries, and their advocates to understand the new program.
CMS understands that Medicare physicians and providers may have varying levels of interest and involvement in the new program. Therefore, educational products are now available that range from basic program and beneficiary referral information to materials that cover the program in a more comprehensive way for those Medicare physicians, providers, and pharmacy professionals who choose to take a more active role in assisting or counseling beneficiaries.
To view a presentation by Barry Straube, M.D., Chief Medical Officer, Centers for Medicare & Medicaid Services, Region IX, outlining MMA impact on ESRD patients and networks click here.
Questions on Physician Reimbursement Formula
House Ways and Means Committee Chair Bill Thomas (R-CA) and Health Subcommittee Chair Nancy Johnson (R-CT) wrote to Centers for Medicare and Medicaid Services (CMS) Administrator Mark McClellan, MD, PhD, earlier this month requesting the agency revise the Medicare physician reimbursement formula and prevent impending cuts. Medicare physician reimbursement levels face significant cuts over the next decade unless Congress or CMS revises the underlying formula. Representatives Thomas and Johnson made the same request two years ago to the prior CMS administrator but were told that only Congress could change the Medicare payment formula. The congressional leaders disagree with this assessment and insist CMS has the authority to act independently.
According to the CMS physician fee schedule, the reimbursement rate was scheduled to be reduced by 4.5 percent in fiscal year (FY) 2004. Congress prevented the pending cut as part of the Medicare Prescription Drug and Modernization Act by temporarily suspending use of the formula and instead mandating a 1.5 percent increase. The Medicare law requires the same increase for FY 2005. However, the law reestablishes the formula beginning in FY 2006.
It appears unlikely Dr. McClellan will reverse the earlier CMS decision not to change the formula, but his timeline for making an official decision is uncertain. If he decides not to act, physician organizations will need to convince Congress of the need to approve a formula change before FY 2006.
CMS Launches "Fistula First" Initiative to Improve Care and Quality of Life for Hemodialysis Patients
The Centers for Medicare & Medicaid Services (CMS) announced it is leading a national initiative to increase the use of fistulas in providing hemodialysis for Medicare beneficiaries with ESRD. The "Fistula First" initiative aims at having fistulas placed in at least half of new dialysis patients with a long-range goal of maintaining fistulas in 40 percent of eligible patients who remain on dialysis. Currently, only about 30 percent of Medicare beneficiaries dialyze with a fistula. CMS Administrator Mark McClellan said "there is no more striking example of where CMS should use its leadership position than to partner with the renal community and improve the lives of patients with kidney disease."
CMS is funding and overseeing the Fistula First initiative, which brings together a project team that is working with major stakeholders, including dialysis providers, primary care physicians, nephrologists, vascular access surgeons, interventional radiologists/ nephrologists, professional societies and patient advocacy groups. The initiative is leading to a broad national partnership to ensure that many more hemodialysis patients have the opportunity to receive a fistula. CMS' ESRD Network program will spearhead the implementation of the initiative. Click here for more information on this initiative.
