In This Issue...
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Policy Board Events at Renal Week
Learn about the exciting policy board events taking place at Renal Week.
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Regulatory Issues
Sustainable Growth Rate (SGR); Quality Measures Released by CMS; and CMS Medicare Policy on Consultations are highlights in this section.
- NIH/Research Related Issues
This section addresses the following topics: NIH Reauthorization and Labor, Health, and Human Services (LHHS) Appropriations; New Ethics Rules at NIH Produce Unwanted Effect; and a new website for NIDDK.
1. Welcome Message from Dr. Himmelfarb
Welcome! This is the first installment of what will be a regular update on what is happening in the world of policy as it relates to the ASN and its members. As you have probably heard, the ASN has formed the Public Policy Board whose charge is to develop and build a platform for the organization in the public health arena related to the public health importance and consequences of kidney disease. The three mandates are: 1) assist on a policy level bringing the best possible medical care to patients with kidney disease, 2) support the practice and profession of nephrology in a time of change, and 3) advocate for resources to support kidney disease research. The members of the ASN Public Policy Board are: Connie Davis, Thomas Hostetter, Eric Neilson, Brian Pereira, and Donald Wesson. We hope that you enjoy this monthly update and we look forward to working with our members on these issues. Please do not hesitate to contact us with any questions or concerns. You can reach us via email at policy@asn-online.org.
Sincerely,
Jonathan Himmelfarb, MD
Chair of the ASN Public Policy Board
2. Policy Board Events at Renal Week
Renal Week is quickly approaching. The Policy Board has some exciting and informative events planned to help add a public policy aspect to your itinerary.
Town Hall Meeting with the ASN Policy Board
Thursday, November 16, 1:30pm – 3:30pm
Room 6 C
This will be a great opportunity to make your views heard and to interact directly with members of the newly-constituted ASN Policy Board. Your input will help the board determine their legislative priorities and agenda moving forward. Discussions will cover medical, economic, political, societal, and ethical issues facing the renal community including, but not limited to, restricted National Institutes of Health research funding and the struggle at the Centers for Medicare and Medicaid Services as they seek to improve medical care for ESRD beneficiaries while carefully controlling costs. This session will be moderated by Jonathan Himmelfarb, MD, chair of the Policy Board and will feature the members of the Policy Board as panelists.
State-of-the-Art Lecture:
“Kidney Disease Research within the NIH Roadmap: Strategies for the Future”
Elias A. Zerhouni, MD, Director, National Institutes of Health
Friday, November 16, 9:45am – 11:00am
Hall D
This exciting lecture will be given by the current Director of the National Institutes of Health, Dr. Elias A. Zerhouni. It will take place immediately following the Plenary Session on Friday morning and promises to offer interesting insight into where biomedical research in general and kidney disease research in particular is headed at the NIH.
3. Regulatory Issues
Sustainable Growth Rate (SGR)
ASN staff recently attended meetings hosted by the American Medical Association to discuss the SGR pay cut. The meeting was attended by representatives of medical specialty groups as well as bipartisan staff from the House Energy & Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee. The medical community stressed to the staff members that a multi-year fix is necessary and quality reporting should be voluntary with bonuses given to cover additional administrative costs.
The recently released 2007 Medicare Physician Payment Schedule Final Rule states that there will be a negative update of -5.0% for 2007 due to SGR. (You can view the press release here.) Coupled with expiring geographic adjustments, imaging cuts due to the Deficit Reduction Act of 2005, fee schedule adjustments based on the 5 year review, and changes in the practice expense methodology, doctors in some specialties will be facing total cuts of 10-15%.
The ASN Policy Board will remain active in the quest to make sure that physicians are reimbursed adequately for the services that they provide in the care of patients with kidney disease and seek help from our membership to educate Congress on the consequences of the cuts. We recently joined with several other medical professional societies to sign a letter to Congress encouraging a physician payment fix before January 1, 2007. You can view the letter here, under Public Policy.
Quality Measures Released by CMS
The Centers for Medicare & Medicaid Services (CMS) has published a list of 86 quality measures that the agency expects to have available at the beginning of 2007 for its Physician Voluntary Reporting Program (PVRP). Included in the 86 are two quality measures for nephrology. You can view the fact sheet and quality measures by clicking here.
CMS plans to expand the PVRP to cover as many medical specialties as feasible using evidence-based, valid measures. Preference will be given to measures that are adopted by the Ambulatory Quality Care Alliance, or that are endorsed by the National Quality Forum. When an endorsement is not available from these two quality groups, CMS will consider input from relevant professional associations and stakeholders, according to the fact sheet. According to CMS, preference will also be given to measures for which electronic data collection currently exists, as an alternative to reporting on claims.
There has been concern that the proposed measures are not sufficiently clear and that the system for development of the guidelines is not well-delineated. Also, it is not clear what will be done with guidelines that could impact more than one specialty. Legislation may be proposed to protect physicians down the road. The ASN staff has been active in attending meetings at the American Medical Association in order to formulate a coordinated response from the entire medical community.
CMS Medicare Policy on Consultations
The ASN recently signed on to a letter from the American Medical Association regarding CMS' Medicare Policy on consultations. The letter addressed portions of the policy that practicing physicians have found to be confusing. In particular, the letter addresses split-shared billing, transfer of care, and documentation required in consultations. You can view the final version of the letter that was submitted to CMS here, under Public Policy.
4. NIH/Research Related Issues
NIH Reauthorization and Labor, Health, and Human Services (LHHS) Appropriations
The Ad-Hoc Group for Medical Research Executive Committee, of which ASN is a member, recently met to discuss the prospects for the LHHS Appropriations and NIH Reauthorization Bills in the lame-duck congressional session. Soon, House and Senate appropriators will set conference allocation (bill) limits prior to the lame-duck session. The conference allocation is important for the LHHS Appropriations Bill because we anticipate an across-the-board cut for all remaining appropriations bills to be considered by Congress. House and Senate members are circulating 'Dear Colleague' letters in support of efforts to add $4 billion to the LHHS Appropriations Bill. If we do not receive a higher conference allocation we likely see a flat budget for the NIH with an overall funding level equal to FY 2006. The Ad-Hoc Executive Committee is working closely with House and Senate Appropriations staff to support the highest possible conference allocation for LHHS appropriations.
The prospect for early Senate action on the NIH Reauthorization Bill during the lame-duck session is in question. Several Senators and senior-level staff have expressed concern that they were not consulted in the drafting of the House bill. In fact, several staffers mentioned that they had not seen the bill's language until recently. We anticipate that key Senators and committee staff will be open to suggestions from concerned health advocates and organizations to modify any and all sections of the bill. However, given anticipated electoral changes in the House and/or the Senate it is unlikely this bill will move expeditiously. ASN staff is closely monitoring the situation and watching for developments. We will be attending a Congressional briefing prior to the lame-duck session that will address these issues.
New Ethics Rules at NIH Produce Unwanted Effect
According to an article recently released by the Associated Press and published by The Washington Post, “nearly 40% of the scientists conducting hands-on research at the National Institutes of Health say they are looking for other jobs or are considering doing so to escape new ethics rules that have curtailed their opportunity to earn outside income.” There is concern that the strict regulations may curtail the ability of the NIH to attract and keep new investigators. However, there are no plans at this time to change the regulations, according to Dr. Elias Zerhouni, Director of the NIH. You can read the article here. You may also click here to view a slide set with more detailed survey results, and a memo on the results is available here.
New Website for NIDDK
The National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) recently unveiled their new website, designed to be more user-friendly to navigate. There are several new features, including “Scientific Areas” that connect researchers to funding opportunities in their fields of interest and an extensive health education section for the public. You can read the press release about the new site here. The new site itself can be accessed via this link.
And Finally,
We hope that you have enjoyed this version of ASN's Renal Policy Express. Past issues will be archived on the ASN website for your reference. Please refer any questions or comments about material from this newsletter to policy@asn-online.org.
Paul Smedberg , Director, Policy and Public Affairs
Susan Owens, Policy and Public Affairs Coordinator
