Chuck Grassley

Federal bill would link Medicare hospital pay to quality

Anne Zieger — Fri, 21 Nov 2008 09:14:55 -0500

Now here's a bill that would scare me a bit if I were a hospital administrator--even if it was inevitable (and it is) that such a measure would be written. Sens. Max Baucus (D-MT) and Chuck Grassley (R-IA) have drafted legislation that would link Medicare reimbursement for inpatient hospital care to the quality of that care rather than the number of services provided.

Yes, this is the way things have been going for some time, between the drive to bundle care--as Geisinger has done with some procedures--and quality incentives, but this definitely takes things a step further in the direction of so-called "value-based purchasing." (Value-based purchasing: now there's a concept that's a million times easier to talk about than to actually realize.)

The bill would kick off the new policy in fiscal 2012 and be phased in over four years through FY 2016. Medicare reimbursement levels would be based on quality standards from a list of measures from several groups, including the National Quality Forum.

To learn more about this bill:
- read this Kaiser Daily Health Policy Report article

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Community benefit standards vary widely across non-profit hospitals

Anne Zieger — Wed, 15 Oct 2008 11:58:07 -0400

Non-profit hospitals continue to struggle with the issue of setting standards for providing community benefits, leading to wide variability in how they report such benefits, according to a new report from the Government Accountability Office.

The report, which was requested by non-profit hospital watchdog Sen. Chuck Grassley (R-IA), reviewed IRS and CMS regs and rulings, state laws, industry guidance and 2006 data from four states. In the report, the GAO noted that with ambiguous federal regulations in place, varying state laws and conflicting policies from industry groups on disclosing aid hospitals have given to communities, it's not too surprising that hospital community benefit reporting is a mess.

GAO researchers noted that federal regs offer the nation's 2,900 private not-for-profit hospitals wide latitude to meet the IRS's 1969 standard for community benefits. For that reason, states are free to make varied interpretations, including widely differing views as to what counts as a benefit (such as whether Medicare losses or bad debt should be included).

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

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Drug company funding for universities under more pressure

Anne Zieger — Fri, 12 Sep 2008 11:38:34 -0400

Lately, universities have been taking a hard line when it comes to gifts from drug companies, with some setting strict limits that ban even pens and Post-It notes with pharma logos on them. Now, universities are scrutinizing drug company funding further, under fire from Sen. Chuck Grassley (R-IA), who's pushing NIH to crack down on universities who don't disclose such funding.

On Tuesday, Sen. Grassley shot off the latest in a series of letters on the topic, this one stating that a researcher working for the University of Texas who worked on an NIH study involving GlaxoSmithKine's Paxil didn't disclose more than $150,000 in fees paid to her by the pharmaceutical firm. Grassley has also slammed Standford, Harvard and the University of Cincinnati for similar disclosure problems. Meanwhile, another 20 universities have been contacted by the Senate Finance committee over questions of whether their faculty face conflict of interest problems in their relationships with pharmas.

Striking fear into the hearts of medical researchers everywhere, Sen. Grassley has said that he'd like to see NIH begin pulling grants from universities that don't report researchers' outside incomes from drug firms as required by law. In the case of University of Texas, we're talking about $5 billion in NIH grants, so the stakes are extremely high. With this kind of firepower pointed at them, expect to see universities make some very public gestures to prove they're making full disclosure in coming months.

To learn more about this controversy:
- read this Wall Street Journal piece (sub. req.)

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Grassley investigates hospital with ties to Obamas

Anne Zieger — Wed, 03 Sep 2008 14:26:45 -0400

Senior Republican Sen. Chuck Grassley (R-IA) has begun asking some hard questions about jobs held by Sen. Barack Obama's wife and one of his best friends. Grassley sent the University of Chicago Medical Center a letter saying he was concerned about reports of the hospital's efforts to steer patients with non-urgent complaints away from the facility's emergency department. This practice, which has drawn little fire in the healthcare community, generally involves directing patients to primary care settings where they can be better served. But apparently, it doesn't sit right with Grassley, who contends that the practice "culls the least profitable patients from its emergency room."

In his letter to the University of Chicago, Grassley asked for financial data, board minutes and other documents related to hiring, job promotion, business contracting and care for the poor. Where jobs were concerned, he focused in on salaries for two senior positions: executive vice president and vice president of community and external relations. The current EVP, Eric Whitaker, is a close friend of the Obamas, and the current vice president of community and external relations is Michelle Obama. Grassley also asked how the center decided how much charity care it would provide.

To find out more about the controversy:
- read this Washington Post article

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Glaxo to report grants to U.S. healthcare groups

Anne Zieger — Mon, 25 Aug 2008 06:48:19 -0400

Bowing to emerging trends favoring such disclosures, drugmaker GlaxoSmithKline has announced plans to publicly report the grants it provides to U.S. healthcare organizations. The report, which will be issued quarterly beginning in February 2009, will include grants provided to hospitals, teaching institutions, managed care organizations, professional associations, patient advocacy groups and CME companies. Details will include the recipient's name, a grant description and the amount provided. Notably absent, however, is information on the pharmaceutical firm's consulting agreements with doctors, a source of controversy in many discussions of pharma financial relationships.

The voluntary disclosures come at a time when both state and federal officials are pushing for such. Massachusetts, in fact, has just passed a law requiring drug companies and devicemakers to report payments of more than $50 made to medical providers. Meanwhile, Sen. Chuck Grassley (R-IA) is sponsoring a federal bill that would establish similar rules.

To learn more about Glaxo's plans:
- read this Modern Healthcare piece (reg. req.)

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Grassley to introduce imaging self-referral bill

Anne Zieger — Mon, 28 Jul 2008 10:02:18 -0400

Sen. Chuck Grassley (R-IA) plans to introduce a bill that he says would cast a spotlight on physicians' financial incentives to order imaging services. The bill, which will be called the Medicare Imaging Disclosure Sunshine Act of 2008, will require doctors to disclose any interest in imaging services at the time of referral. The bill would also require doctors to offer Medicare beneficiaries a list of alternative providers.

In making his announcement regarding the bill, Grassley noted that a GAO report concluded that Medicare Part B spending on imaging has more than doubled between 2000 and 2006 to about $14.1 billion. He also noted that imaging spending varies dramatically from state to state, with Medicare spending $62 per beneficiary on in-office imaging in Vermont, while it spends $472 per beneficiary in Florida. In his view, that suggests that some regions overuse imaging services.

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

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Senate bill filed to block DME competitive-bidding program

Anne Zieger — Thu, 19 Jun 2008 11:12:45 -0400

Senate leaders have joined colleagues in the the House in sponsoring a bill that would delay a Medicare program calling for competitive billing on durable medical equipment. As things stand, the first bidding round would begin on July 1st, at which time CMS would pay contracted suppliers a set dollar amount for various DME equipment, prosthetics, orthotics and supplies. Some DME groups, however, have complained that the program failed to specify financial standards for the first bidding round, is unfair to smaller providers and could compromise quality. Some of these groups are so opposed to the program that they have filed suit to stop it from moving forward.

The bill, sponsored in the Senate by Finance Committee Chairman Max Baucus (D-MT) and ranking member Sen. Chuck Grassley (R-IA) would eliminate the first round of bidding and delay further implementation of the program for two years. Previously, Reps. Pete Stark (D-CA) and Dave Camp (R-MI) filed legislation on their side of Congress to delay the program.

To learn more about the DME bidding controversy:
- read this Modern Healthcare piece (reg. req.)

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Did Glaxo conceal Paxil users' risk of suicide?

Fri, 13 Jun 2008 06:59:55 -0400

Did drugmaker GlaxoSmithKline conceal suicide risks for users of its antidepressant Paxil within the mountains of data it submitted to the FDA? That's a question Sen. Chuck Grassley (R-Iowa) would like to see answered, and in some detail. Grassley would like to find out who within Glaxo knew what, and when, about the medicine's possible link to increased suicidal behavior. In his correspondence with the FDA and HHS Secretary Michael Leavitt, Grassley notes that the U.K. recently concluded that the firm withheld safety information when submitting data for approval in Europe. Now, he wants to know whether Glaxo did the same in the U.S. In testimony on the Senate floor, Grassley noted that a report by one Harvard researcher contends that Glaxo probably knew about Paxil safety concerns all the way back in 1989, when it first asked the FDA for approval--and that it probably manipulated studies to diminish the perceived risk.

To learn more about Grassley's concerns:
- read this Wall Street Journal blog entry

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