Senate Finance Committee

Providers want CMS to pay more for compliance with P4P

Anne Zieger — Tue, 16 Sep 2008 12:30:19 -0400

While they think the pilot projects and other efforts by CMS to improve quality should be expanded, providers last week told Congress that they want to see Medicare pay more to help with the costs of participating. Legislators on the Senate Finance Committee convened a panel on pay-for-performance programs, taking comments from providers, insurers and policy experts on how to best foster quality improvement measures in federal healthcare programs. For example, Mark Povroznik, director of quality initiatives for 311-bed United Hospital Center of Clarksburg, WV, told the committee that maintaining top scores in quality improvement projects requires additional resources, particularly in the health IT arena, which "carries a huge price tag," he noted.

Mark Wynn, director of the CMS division of payment policy demonstrations, noted that the CMS/Premier Hospital Quality Incentive Demonstration Project, which has gone on since 2003 and includes more than 250 hospitals, has a budget of $12 million per year for 2006 through 2009. While there are no current plans to increase bonuses under the current CMS/Premier project, the agency recently submitted a proposal for value-based purchasing that could give providers the chance to earn higher incentives. Under the new proposal, the bonus per hospital would be higher than what the hospitals are earning under the Premier program.

To learn more about this issue:
- read this Modern Healthcare piece (reg. req.)

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Bill would create federal research institute

Anne Zieger — Mon, 04 Aug 2008 08:51:49 -0400

A new bill has been introduced in the Senate that would create a central federal agency tasked with researching the benefits of various procedures in treating common medical conditions. The bill caps more than a year of discussion and hearings on the Hill on the topic of creating such an agency, which is backed by several high-profile public health experts, including former HCFA (now CMS) administrator Gail Wilensky.

The current bill, backed by Senate Finance Committee Chairman Max Baucus (D-MT) and Budget Committee Chairman Kent Conrad (D-ND), establishes the Health Care Comparative Effectiveness Research Institute. The Institute would be a public-private partnership that would conduct research on surgical procedures, pharmaceuticals, medical devices and other key treatments. Its board would include doctors, patients and drug and device maker representatives. The center, whose annual costs should exceed $300 million after five years, would be paid for by fees from public and private payers, and would operate outside of the government.

To learn more about the proposed center:
- read this Modern Healthcare piece (reg. req.)

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Senate to investigate Brown University doctor

Sterling Meyers — Mon, 21 Jul 2008 14:41:25 -0400

As the Senate Finance Committee continues investigating doctors with too-tight relationships with pharmas, the head of psychiatry at Brown University, Dr. Martin Keller, is the latest target for scrutiny. The ranking member of the Senate committee, Sen. Charles E. Grassley (R-IA), is checking out fees that pharmas paid Keller for researching the antidepressant Paxil. About 30 other physicians from as many as 20 universities are also being investigated.

To read more about the investigation:
- read this Boston Globe article

Related Article:
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Non-profit hospital tax breaks attacked by Grassley, again

Wed, 11 Jun 2008 06:59:56 -0400

Well, folks, if you thought Sen. Chuck Grassley (R-Iowa) was ready to take a breather on the subject of non-profit hospital tax breaks, think again. This week, the Senator used a hearing on incentives for lowering the rates of the uninsured and under-insured in the U.S. to bring the topic up again. At the hearing, which was held by the Senate Finance Committee, Grassley had a 53-year-old leukemia patient testify about her experience with the M.D. Anderson Cancer Center, which demanded a total of $105,000 in cash up front before it would provide chemotherapy.

In discussing the issue, Grassley noted that M.D. Anderson is a non-profit "funded through taxpayers' dollars and charitable gifts," making its actions particularly troubling. As he has many times in the past, Grassley hinted that non-profit tax breaks could be in danger if the hospitals engage in this type of billing practice.

Among other things, Grassley has also proposed that rules be enacted to set minimum levels of charitable spending a not-for-profit would be required to make to keep its tax-free status. Meanwhile, the IRS is taking a closer look at such issues as it rolls out its Form 990, Schedule H, which will require detailed reporting on charitable spending by hospitals.

To learn more about Grassley's discussion at the hearing:
- read this Wall Street Journal blog item

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Medicare reform bill may include bonuses, increases for MDs

Tue, 03 Jun 2008 06:59:57 -0400

If Sen. Max Baucus (D-MT) gets his way, pending Medicare reforms will offer physicians several new payment options, including bonus payments and increased payments. That, at least, is the word coming from the Senate Finance Committee, according to a report in Modern Healthcare. Not only is Baucus amenable to halting the planned 10 percent cut in Medicare payments to doctors for more than 18 months, he's also prepared to seek a 0.5 percent increase for next year. What's more, he'd like to increase the bonus doctors receive for participating in the Physician Quality Reporting Initiative to 2 percent from 1.5 percent. His bill also would include an e-prescribing provision that would first give bonuses to doctors who install the technology, then penalize doctors by 2 percent in 2013 and beyond for those who don't adopt it.

To learn more about the pending bill:
- read this Modern Healthcare piece (reg. req.)

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Congress says drugmakers held back Vytorin data

Tue, 01 Apr 2008 07:59:58 -0400

Cholesterol drug Vytorin--and makers Merck and Schering-Plough--have been under fire for months since a study suggested that the expensive combo med works no better than much less costly Zocor. Things became even hotter when it came to light that the American Heart Association was vouching for Vytorin despite the study results, perhaps because it gets almost $2 million a year from Merck and Schering-Plough. Now, Vytorin is under fire from a Senate Finance Committee, which has released evidence suggesting that Merck and Schering-Plough delayed negative research data from a test of Vytorin vs. cheaper statins to avoid a drop in the drug's sales.

In a letter to the pharmas, Sen. Chuck Grassley (R-IA) notes that while the results of the study, known as ENHANCE, remained in the can, the companies spent about $3.5 million on a marketing campaign to get doctors to switch patients to Vytorin from cheaper drugs.

To learn more about the latest Vytorin controversy:
- read this Associated Press piece
- read Sen. Grassley's letter to the drug companies (.pdf)

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SPOTLIGHT: Hospital leaders OK with value-based purchasing

Fri, 07 Mar 2008 06:59:52 -0500

While they're afraid that it might be used to cut their reimbursement, value-based purchasing approaches should work, according to a group of hospital leaders convened by the Senate Finance Committee. On hospital head who spoke at a roundtable meeting, Cedars-Sinai Health System president and CEO Thomas Priselac, said that value-based purchasing can actually offer "great advantages" to the industry. The key, execs agreed, was not to make this an excuse to cut Medicare's budget by taking it out of the skin of providers. Article

AMA booted from Senate Medicare talks

Tue, 19 Feb 2008 06:59:57 -0500

The American Medical Association has lost a major lobbying round. The Senate Finance Committee has banned the group from discussions on an upcoming legislative package that would halt a 10 percent cut to physician fees. Right now, the 10 percent cut will go into effect July 1 unless Congress takes action. The AMA, never shy about pressing for its needs, would like to see the Finance Committee delay the 10 percent cuts for 18 months, as well as boost physician payments by 1.5 percent.

However, the AMA may have to watch from the sidelines now. According to published reports, Senate Finance Committee Chair Max Baucus (D-MT) seems to have lost patience with the AMA, which he says broke a confidentiality agreement on Medicare talks last year when it shared insider information with its state affiliates. Also, the AMA committed a faux pas when it supported a 2006 budget provision, then complained about it later, reports say.

To learn more about the AMA's lobbying disappointment:
- read this Kaiser Daily Health Policy Report item

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SPOTLIGHT: Bill could include Medicaid funding increase

Fri, 01 Feb 2008 06:59:52 -0500

As federal legislators work on a second package to stimulate the declining U.S. economy, they're including additional funds for state Medicaid programs. However, some observers say it's unlikely to get through unless legislators find a way to fund the Medicaid increases as they're doled out, possibly through tax increases--and those are unlikely to win favor with congressional Republicans and the White House, according to Senate Finance Committee Chair Max Baucus (D-MT). Article

AMA opposes revision of Medicare bill

Mon, 10 Dec 2007 06:59:57 -0500

The American Medical Association recently drafted a letter to the Senate Finance Committee, stating that the Medicare Bill currently under Senate consideration should not reverse a reduction shift the cost of reversal for physician reimbursements to future years. The AMA circulated the letter to other lobbying groups for signatures but did not send it, since Senate Finance Chair Max Baucus (D-MT) "canceled the mark-up of the Medicare bill in favor of direct negotiations with the House Ways and Means Committee." Baucus recently debated this issue with committee Republicans, going back and forth about reversing reductions in Medicare physician reimbursements for one or two years.

In the draft, the AMA urges the Committee not to "rely on 'balloon financing,'" stating that "if the Finance Committee were to propose such an approach, the undersigned organizations would be forced to oppose the proposal."

To find out more:
- read this Kaiser Daily Health Report article

Related articles:
New Medicare bill would stop 10% MD pay cut. Article
Senate may roll back 10 percent Medicare fee cut for MDs. Report
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Physician Medicare cut may be eliminated. Report