Promoting Health Information Technology Act of 2008

HR 1467 - 10,000 Trained by 2010 Act - in it's entirety, especially the workforce provisions HR 2406 - Healthcare Information Technology Enterprise Integration Act - health IT aspects with emphasis on terminology & classification HR 4105 - the Medicare Recovery Audit Contractor Program Moratorium Act of 2007 - Interested in the entire bill HR 3800 - the Promoting Health Information Technology Act - Interest in the entire legislation and its focus on health information technology S 1814 - Health Information Privacy and Security Act - Interest in the entire legislation and its focus on health information technology and privacy S 1693 - WIRED for Health Care Quality Act - Interest in the entire legislation and its focus on health information technology HR 5442 - the TRUST Health Information Act of 2008 - Interest in the entire legislation and its focus on health information technology and privacy S 628 - The Critical Access to Health Information Technology Act - Interested in the legislation's provisions on ICD-10, HIPAA and standards S 605 - Allied Health Reinvestment Act - interested in the legilation's focus on growing the allied health workforce with includes health information management professionals HR 6357 - the The PROTECHT Act - Interest in the entire legislation and its focus on health information technology and privacy HR 6345 - the Patient-Controlled Health IT Act - interested in the legislation's provisions on health informaiton technology, personal health records and incentives HR 6179 - Interested in the legilation's provisions on health information technology and ICS-10. HR 2991 - the Independent Health Record Trust Act - Interested in the legislation's provisions on health record trusts (banks), personal health records and health information technology HR 2043 - the Medicaid Access Project through Health IT Act - interested in the bill's incentive programs for health IT through Medicaid HR 1952 - the National Health Information Infrastructure Incentive Act - Interested in the bill's HIT provisions and incentive provisions HR 1368 - the Personalized Health Information Act - Interested in the bill's entirety HR 6898 - the Health-e Information Technology Act of 2008 - Interested in the bill's entirety

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

House Emergency Retiree Health Benefits Protection Act - H.R. 1322 Paul Wellstone Mental Health and Addiction Equity Act - H.R. 1424 Tax Equity for Health Plan Beneficiaries Act - H.R. 1820 Promoting Health for Future Generations Act H.R. 2639 Michelles Law H.R. 2851 Long-Term Care Affordability and Security Act of 2007 H.R. 3363 Defenders of Freedom Tax Relief Act H.R. 3997 Technologies for Restoring Users Security and Trust in (TRUST) in Health Information Act of 2008 H.R. 5442 Taxpayer Assistance and Simplification Act of 2008 - H.R. 5719 ERISA Amendments H.R. 6142 Pension Protection Act ERISA Amendments Act of 2008 H.R 6143 Promoting Health Information Technology Act of 2008 H.R. 6179 Patient-Controlled Health IT Act H.R. 6345 Protecting Records, Optimizing Treatment and Easing Communication Through Healthcare Technology Act, The Pro (TECHT) T Act of 2008 H.R. 6357 Health Insurance Source of Injury Clarification Act of 2008 H.R. 6908 Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act H.R. 6983 Technical Correction S. 3712: Paul Wellstone and Pete Domenici Mental Health Parity Addiction Equity Act H.R. 6938 Several Approaches to Reduce the Uninsured Act H.R. 7129 Senate Mental Health Parity Act S. 558 Tax Equity for Domestic Partner and Health Plan Beneficiaries Act S. 1556 Wired for Health Care Quality Act S. 1693 Biologics Price Competition and Innovation Act 0f 2007 S. 1695 Long-Term Care Affordability and Security Act of 2007 S. 2337 Comparative Effectiveness Research Act S. 3408 Technical Correction S. 3712: Paul Wellstone and Pete Domenici Mental Health Parity Addiction Equity Act H.R. 6938 Discussion Draft of Legislation Requiring Form W-2 Reporting of Employer-Provided Health Care Costs - Submitted comments to a group of Senators Health Reform Call to Action Health Reform 2009 Finance & HELP Committees Regulatory communication with covered federal officials on legislative issues DOL/EBSA Genetic Information Nondiscrimination Act of 2008 (GINA) DOL Technical Correction S. 3712: Paul Wellstone and Pete Domenici Mental Health Parity Addiction Equity Act H.R. 6938 IRS proposed requirements for filing excise taxes

Client expense: $210,392 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

H.R. 6179 - Promoting Health IT Act; HR 6357 PROTECHT ACT; S. 1693 Wired for Healthcare Quality Act.

Client expense: Not reported · Firm income: $40,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 2472, the Essential Oral Health Care Act HR 1781 and S. 739, Children's Dental Health Improvement Act HR 2371, Deamonte's Law S. 3064 Oral Health Initiative Act of 2008 S. 3708 Health Professions Primary Care Reinvestment Act H.R.1343 : To amend the Public Health Service Act to provide additional authorizations of appropriations for the health centers program under section 330 of such Act, and for other purposes (COmmunity Health Center Reauthorization). HR 3186 and S. 1906, Meth Mouth Prevention and Community Recovery Act HR 3187 and S. 1907, Meth Mouth Correctional Costs HR 1108 and S. 625, Family Smoking Prevention and Tobacco Control Act HR 6331 Medicare Improvements for Patients and Providers Act of 2008 HR 976 and 3162, Children's Health and Medicare Protection Act of 2007 (SCHIP Reauthorization) S. 1893 Children's Health Insurance Program Reauthorization Act of 2007 (SCHIP Reauthorization) S.2723 and H.R.5549 Deamonte Driver Dental Care Access Improvement Act S. 3067 Dental Health Improvement Act of 2008 Secretarys Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 S.901 and HR 1343 Health Centers Renewal Act of 2007 HR 6357 Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act H.R. 2184, Enhanced Health Care Value for All Act of 2007 H.R. 3163 and S. 771, Child Nutrition Promotion and School Lunch Protection Act of 2007 S 1693 Wired for Health Care Quality Act S 334 Healthy Americans Act HR 5442 Technologies for Restoring Users' Security and Trust (TRUST) in Health Information Act HR 6331/S3101 Medicare Improvements for Patients and Providers Act HR 6898 Health-e Information Technology Act of 2008 S 628 Critical Access to Health Information Technology Act of 2007 S 980 Online Pharmacy Consumer Protection Act of 2007 S 1408 Health Information Technology Act of 2007 S 2408 Medicare Electronic Medication and Safety Protection (E-MEDS) Act S 2729 Ensuring the Future Physician Workforce Act of 2008 S 3072 Making Health Care More Affordable Act of 2008 HR 1467 10,000 Trained by 2010 Act HR 2377 Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology (ADOPT HIT) Act of 2007 HR 6613 Improving Dental Access in Underserved Communities Act of 2008 HR 5885 Health Information Technology Promotion Act of 2008 HR 6179 Promoting Health Information Technology Act of 2008 S 1019 Universal Health Care Choice and Access Act S 1783 Ten Steps to Transform Health Care in America Act S 2105 A bill to provide for the establishment of the Federal Health Care Board. S. 3408 Comparative Effectiveness Research Act of 2008 H.R. 6845 Fair Copyright in Research Works Act of 2008

Client expense: $434,564 · Firm income: Not reported

Government targets: Air Force, Dept of, Army, Dept of (Other), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Indian Health Service, Internal Revenue Service (IRS), Natl Institute of Standards & Technology (NIST), Natl Institutes of Health (NIH), Navy, Dept of, SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, U.S. Marines, Veterans Affairs, Dept of (VA)

Provisions of the Presidents FY2008 Budget and related appropriations legislation (S Con Res 70) related to implementation of the Medicare Advantage and Prescription Drug Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. S 3101, and HR 6331, the Medicare Improvements for Patients and Providers Act of 2008. Supported provisions that prevent the 10.6% cut in Medicare physician payment that was called for in the November 27, 2007 CMS final rule implementing the Medicare physician fee schedule. The bill replaces the 10.6% cut with an increase through 2008, and extended the 1.0 floor on the geographic adjustor for physician work initially included in the Medicare Modernization Act of 2003 through 2008. S.2812, the Medicare Improvement Act of 2008 introduced by senator Kent Conrad. This legislation will expand the number of originating sites, the list of eligible practitioners, and provide an advisory committee to CMS and Congress on payment issues related to services provided via TeleHealth. The Physician Payment Sunshine Act, S. 2029, introduced by Senator Kohl with Senator Grassley to create accountability among physicians and the manufacturers of drugs and devices that physicians utilize and prescribe for their patients. This legislation would require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. The Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Grassley to mitigate current inequities in Medicare reimbursement, improve access to health services in rural and underserved areas, and will begin to close the gap between Medicare reimbursement and the cost of providing services in predominantly rural areas. The legislation establishes a 1.0 floor for physician work and practice expense adjustments. It also revises the work and practice expense formulas to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. The bill also extends the five percent incentive payments for primary care and specialty physicians in scarcity areas. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and sought the endorsement of the Wisconsin delegation, and other Senators and Representatives that serve on the Committees with jurisdiction over the Medicare program. Sustainable Growth Rate Medicares SGR mechanism unfairly links physician payment updates to factors unrelated to patients needs and the cost of providing patient care. Reform proposals include reimbursement updated on a market basket basis, removal of prescription drugs from the calculation of Medicare Part B costs, and rebasing Part B to reflect current rather than cumulative costs. Pay-for Reporting and Performance (Value Based Purchasing) Currently the prevailing methods of paying for health care in the US neither incent nor reward providing high quality care. The rising costs of care coupled with the increasing awareness of poor quality care have made clear the need for a transformation in the way health care is financed. In the fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the unanticipated, but now recognized effect of economically stimulating growth in the numbers of services provided by physicians. Medicare must implement quality based payments for physician services, and capture the data on performance measures utilizing available claims-based data recoverable through enhanced IT functions. In 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In late 2006 CMS renamed PVRP the Physicians Quality Reporting Initiative. (PQRI) In the PQRI program CMS calls on physicians to report on evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). For reporting purposes physicians will utilize provisional G- Codes developed by CMS to indicate whether a patient received a service, did not receive the service, was not a eligible candidate to receive the service, or would not be considered a patient under the care of the physician at the time of the service. Marshfield Clinic has recommended that CMS allow medical groups to electronically report quality measures in an aggregated, periodic, statistically valid basis to PQRI; and re-focus the PQRI on high cost/high volume disease states. Marshfield Clinic supports a request for CMS authorization and funding for a multi-center demonstration project with access to vast data resources across multiple states. This proposed project will connect treatments with outcomes and develop quality metrics that reflect the realities of the care setting and the severity of the patients illness. Information Technology Under current law the capital and operating expenses of installing and maintaining an electronic medical record are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS measurement of current physician practice expenses reflect minimal expense associated with IT. Congress should provide incentives for EMR adoption, and should establish standards to facilitate the sharing and exchange of data. S. 1693, the Wired for Health Care Quality Act introduced by Senator Ted Kennedy (D-MA) and Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. HR 6357, the Protecting Records, Optimizing Treatment and Easing Communications through Health Care Technology Act of 2008 is important legislation that promotes Health Information Technology and the protection of patients personal health information. HR 6357 codifies ONCHIT, provides grants and loans for HIT, but most importantly the bill creates new privacy and security provisions which require notification of breaches of PHI by covered entities and business associates. The bill also includes restrictions on certain disclosures of PHI allowing patients to request that their information not be released to health plans in certain circumstances. It also includes an impractical consent provision that requires additional patient consent if the PHI is utilized in operations, such as peer review, quality review, standard of care review, malpractice review, or best practices analysis. HR 6898 Health-e Information Technology Act of 2008, a bill that includes an estimated $4 billion in incentive payments to Medicare physicians and hospitals which demonstrate successful adoption and use of HIT once initial national technical standards are finalized. Support for privacy enforcement provisions. H.R.6179 the Promoting Health Information Technology Act of 2008 - provisions that encourage and facilitate the adoption of state reciprocity agreements for practitioner licensure in order to expedite the provision across state lines of telehealth services; and provisions that require the Centers of Medicare & Medicaid Services to make federally qualified health centers eligible to participate in demonstration projects related to health records and heath information technology. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS should administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 1.501) in practice expense could be channeled into a narrower corridor of adjustment. Payment Equity Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 07 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. The Rural Medicare Equity Act of 2007 (S 498), introduced by Senator Russ Feingold, Amends title XVIII (Medicare) of the Social Security Act (SSA) to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the physician fee schedule. Rep. Braley introduced HR 2827, the Medicare Equity and Accessibility Act, along with Rep. Adrian Smith (R-Nebraska). This bill will increase the Medicare Part B reimbursement rates in Iowa and other rural states, by making permanent the 1.0 floor on the Geographic Practice Indexes for Work and Practice Expense. Support for Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Chuck Grassley especially provisions that would extend the 1.0 work floor through December 31,2009, and would recognize the equality of physician work in all geographic areas and eliminate differing work index values by establishing a national value of 1.0, effective 2010. Also support provisions for physician practice expense that would establish a practice expense floor of 1.0 for 2009 by requiring the Secretary to increase the value of any practice expense geographic index that was below 1.0 to 1.0 for services furnished on or after January 1, 2009 and before January 1, 2010. Subsection (b) would reduce the geographic adjustment for practice expense to 50 percent of the current adjustment for employee wages and rent, effective 2010. Support for Rep. Ron Kinds concept of a not yet introduced MEDICARE EFFICIENCY BILL that would amend the CHAMP Act (H.R. 3162) 304 in whole, by establishing that the 5% bonus payment would be expanded to the top 10% of efficient counties; and a corresponding 5% efficiency penalty for physicians in the bottom 10% of efficient counties. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage -- (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blended payments. Increases minimum percentage increase to national growth rate. Marshfield Clinic opposes reductions to Medicare Advantage payments in low payment states. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. See Tax Relief and Health Care Act provisions below (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services to determine where growth in the volume of imaging services is appropriate and develop workable solutions to control inappropriate imaging utilization. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term. Also supports efforts to eliminate the 2% threshold for payments and the 5% limitation on payments. Regulatory clarification of Medicare anti-markup issues, and postponement of the effective date of CMS final rule regarding the applicability of the anti markup provisions with respect to: (1) the technical component of a purchased diagnostic test and (2) any anatomic pathology diagnostic testing services furnished in space that is utilized by a physician group practice as a "centralized building" for purposes of complying with the physician self-referral rules and does not qualify as a "same building".

Client expense: $100,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

H.R. 3800, Promoting Health Information Technology Act S. 1456, Federal Employees Electronic Personal Health Records Act of 2007 S. 631, Remote Monitoring Access Act of 2007 S. 2408, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 H.R. 4296, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 S. 628, Critical Access to Health Information Technology Act of 2007 S. 1814, Health Information Privacy and Security Act S. 1915, Electronic Prescription Drug Act of 2007 S. 2029, Physician Payments Sunshine Act of 2007 H.R. 2991, Independent Health Record Trust Act of 2007 S. 1695, Biologics Price Competition and Innovation Act of 2007 S. 1693, Wired for Health Care Quality Act H.R. 1368, Personalized Health Care Quality Act S. 1783, Ten Steps to Transform Health Care in America Act S. 321, Fostering Independence Through Technology Act of 2007 H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication Through Healthcare Technology Act H.R. 6179, Promoting Health Information Technology Act H.R. 6898, Health-e Information Technology Act of 2008 S. 1456, The Federal Employees Electronic Personal Health Records Act of 2007

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HR 1467 - 10,000 Trained by 2010 Act - in it's entirety, especially the workforce provisions HR 2406 - Healthcare Information Technology Enterprise Integration Act - health IT aspects with emphasis on terminology & classification HR 4105 - the Medicare Recovery Audit Contractor Program Moratorium Act of 2007 - Interested in the entire bill HR 3800 - the Promoting Health Information Technology Act - Interest in the entire legislation and its focus on health information technology S 1814 - Health Information Privacy and Security Act - Interest in the entire legislation and its focus on health information technology and privacy S 1693 - WIRED for Health Care Quality Act - Interest in the entire legislation and its focus on health information technology HR 5442 - the TRUST Health Information Act of 2008 - Interest in the entire legislation and its focus on health information technology and privacy S 628 - The Critical Access to Health Information Technology Act - Interested in the legislation's provisions on ICD-10, HIPAA and standards S 605 - Allied Health Reinvestment Act - interested in the legilation's focus on growing the allied health workforce with includes health information management professionals HR 6357 - the The PROTECHT Act - Interest in the entire legislation and its focus on health information technology and privacy HR 6345 - the Patient-Controlled Health IT Act - interested in the legislation's provisions on health informaiton technology, personal health records and incentives HR 6179 - Interested in the legilation's provisions on health information technology and ICS-10. HR 2991 - the Independent Health Record Trust Act - Interested in the legislation's provisions on health record trusts (banks), personal health records and health information technology HR 2043 - the Medicaid Access Project through Health IT Act - interested in the bill's incentive programs for health IT through Medicaid HR 1952 - the National Health Information Infrastructure Incentive Act - Interested in the bill's HIT provisions and incentive provisions HR 1368 - the Personalized Health Information Act - Interested in the bill's entirety HR 6898 - the Health-e Information Technology Act of 2008 - Interested in the bill's entirety

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Electronic Health Records- Ensure legislation would not adversely impact pathologists and advance the implementation of health IT to modernize health records and improve the delivery of health care (H.R. 2626, the Comprehensive HealthCARE act of 2007, H.R. 6179, the Promoting Health Information Technology Act of 2008, S.1693 and H.R. 3800, the Wired for Health Care Quality Act)

Client expense: $323,257 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE

SCHIP Reauthorization support passage of and expansion to include oral health benefits for children, including HR.976, S.1893, HR.3162, and S.2499; S.1693, Wired for Health Care Quality Act adoption of; and interest in potential changes to HIPPA standards and coding provisions; HR.1781/S.739, Childrens Dental Health Improvement Act; and monitor general health care reform proposals; S. 625/HR. 1108, Family Smoking Prevention and Tobacco Control Act. S.739/HR.1781, Children's Dental Health Improvement Act. S.2723, Deamonte Driver Dental Care Access Improvement Act of 2008. HR. 6357, PRO(TECH)T Act of 2008. HR. 6179, Promoting Health Information Technology Act of 2008. HR. 6898, Health e-Information Technology Act. Oral health care legislation in general.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3800, Promoting Health Information Technology Act S. 1456, Federal Employees Electronic Personal Health Records Act of 2007 S. 631, Remote Monitoring Access Act of 2007 S. 2408, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 H.R. 4296, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 S. 628, Critical Access to Health Information Technology Act of 2007 S. 1814, Health Information Privacy and Security Act S. 1915, Electronic Prescription Drug Act of 2007 S. 2029, Physician Payments Sunshine Act of 2007 H.R. 2991, Independent Health Record Trust Act of 2007 S. 1695, Biologics Price Competition and Innovation Act of 2007 S. 1693, Wired for Health Care Quality Act H.R. 1368, Personalized Health Care Quality Act S. 1783, Ten Steps to Transform Health Care in America Act S. 321, Fostering Independence Through Technology Act of 2007 H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication Through Healthcare Technology Act H.R. 6179, Promoting Health Information Technology Act H.R. 6898, Health-e Information Technology Act of 2008 S. 1456, The Federal Employees Electronic Personal Health Records Act of 2007

Client expense: $205,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Protection of critical infrastructure and cyber security. Licensing, competition, and government procurement in the software industry. HHS IT e-health procurement. Private sector preparedness; cyber research and development. Standards and interoperability. H.R. 836, Cyber-Security Enhancement and Consumer Data Protection Act of 2007. S. 2213, Cyber-Crime Act of 2007. H.R. 2290, Cyber-Security Enhancement Act of 2007. H.R. 4175, Privacy and Cybercrime Enforcement Act of 2007. H.R. 3800, Promoting Health Information Technology Act. S. 1693, Wired for Health Care Quality Act. H.R. 2272 (P.L. 110-69), To invest in innovation through research and development, and to improve the competitiveness of the United States. China SED/JCCT. H.R. 5442, TRUST in Health Information Act of 2008. S. 334 (H.R. 3163), Healthy Americans Act. H.R. 2406, To authorize The National Institute of Standards and Technology to increase its efforts in support of the integration of the healthcare information enterprise in the United States. S. 1814, Health Information Privacy and Security Act. H.R. 4791 Federal Agency Data Protection Act. H.R. 5983, DHS CIO bill. H.R. 275, Global Online Freedom Act of 2007, and related Senate concerns regarding voluntary business principles. H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 (PRO-(TECH)T Act of 2008. Competition in the online advertising and software markets. Competitiveness and the high-tech sector. H.R. 6060, S. 2168, Identity Theft Enforcement and Restitution Act of 2008. H.R. 6179, Promoting Health Information Technology Act of 2008.

Client expense: $1,980,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Science Foundation (NSF), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Copyright Office, U.S. Trade Representative (USTR)

S. 2908 Medicare Card Security Act of 2008, to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; H.R. 5442 TRUST in Health Information Act of 2008, to provide individuals with access to health information of which they are a subject, to ensure personal privacy, security, and confidentiality with respect to health related information in promoting the development of a nationwide interoperable health information infrastructure, to impose criminal and civil penalties for unauthorized use of personal health information, to provide for the strong enforcement of these rights, to protect States' rights, and for other purposes; S. 1814 Health Information Privacy and Security Act, a bill to provide individuals with access to health information of which they are a subject, ensure personal privacy with respect to health related information, promote the use of non-identifiable information for health research, impose criminal and civil penalties for unauthorized use of protected health information, to provide for the strong enforcement of these rights, and to protect States' rights; H.R. 6179 Promoting Health Information Technology Act of 2008, to encourage and enhance the adoption of interoperable health information technology to improve health care quality, reduce medical errors, and increase the efficiency of care; H.R. 6357 Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act of 2008, to amend the Public Health Service Act to promote the adoption of health information technology, and for other purposes; H.R. 6898 Health-e Information Technology Act of 2008, to promote the adoption and meaningful use of health information technology, and for other purposes.

Client expense: $3,950,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA)

H.R. 1424, Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (as included in the Emergency Economic Stabilization Act of 2008), provisions on mental health parity and physician-owned hospitals H.R. 6983, Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, all provisions S. 558 Mental Health Parity Act of 2007, all provisions S. 3335, Jobs, Energy, Families, and Disaster Relief Act of 2008, provisions on mental health parity H.R. 6049, Energy and Tax Extenders Act of 2008, provisions on mental health parity H.R. 6357, PRO(TECH)T Act of 2008, all provisions H.R. 6898, Health-e Information Technology Act of 2008, all provisions S. 1693, Wired for Health Care Quality Act, provisions relating to data collection, quality, and performance reporting H.R. 6179, Promoting Health Information Technology Act of 2008, all provisions S. 3300, Rural Hospital Assistance Act of 2008, provisions on physician-owned hospitals and self-referral S. 334, Healthy Americans Act, all provisions H.R. 6569, Public Health Emergency Response Act of 2008, all provisions H.R. 1841, AmeriCare Health Care Act of 2007, all provisions H.R. 2357, MediKids Health Insurance Act of 2007, all provisions H.R. 5873, Family Leave Insurance Act of 2008, all provisions H.R. 5639, Physical Activity Guidelines for Americans Act of 2008, all provisions H.R. 3257, Fitness Integrated with Teaching Kids Act, all provisions S. 3575, Labeling Education and Nutrition Act of 2008 (LEAN Act of 2008), all provisions H.R. 2833, Preexisting Condition Exclusion Patient Protection Act of 2007, all provisions H.R. 2842, Children's Health Protection Act of 2007, all provisions H.R. 6845, Fair Copyright in Research Works Act, all provisions H.R. 3544, Catalyst to Better Diabetes Care Act of 2007, all provisions H.R. 1532, Comprehensive Tuberculosis Elimination Act of 2007, all provisions H.R. 2994, National Pain Care Policy Act of 2007, all provisions H.R. 1283, Arthritis Prevention, Control, and Cure Act of 2007, all provisions S. 2731, to improve the oversight and regulation of tissue banks and the tissue donation process, and for other purposes, all provisions S. 3040 and H.R. 6100, Kid-Safe Chemicals Act of 2008, all provisions H.R. 2464, to amend the Public Health Service Act to provide a means for continued improvement in emergency medical services for children, all provisions H.R. 7192, Preserving Patient Access to Primary Care Act, all provisions H.R. 758, Breast Cancer Patient Protection Act of 2008, all provisions S. 3354, Volunteer Healthcare Program Act of 2008, all provisions S. 3408, Comparative Effectiveness Research Act of 2008, all provisions H.R. 6752 and S. 3396, Independent Drug Education and Outreach Act of 2008, all provisions S. 1695, Biologics Price Competition and Innovation Act of 2007, all provisions H.R. 5620, Fresh Produce Safety Act, all provisions H.R. 1038 and S. 623, to amend the Public Health Service Act to provide for the licensing of comparable and interchangeable biological products, and for other purposes, all provisions H.R. 1956, Patient Protection and Innovative Biologic Medicines Act of 2007, all provisions S. 1505, Affordable Biologics for Consumers Act, all provisions H.R. 6498 and S. 976, Genomics and Personalized Medicine Act of 2008, all provisions H.R. 2823, Fair Balance Prescription Drug Advertisement Act of 2007, all provisions Health Disparities Inclusion of Minorities in Clinical Trials Health Savings Accounts Medical devices - standardization of expiration dates Disability Nondiscrimination (Americans with Disabilities Act/hearing interpreters) The Uninsured, AMA's Plan Childhood Obesity Social Security Administration Disability Claims Processing Blood and Blood Components Safety Pregnancy and Lactation Prescription Drug and Biological Products Labeling Children's Health Insurance Program Directive Post-marketing Surveillance of Prescription Drugs DEA - E-Prescribing Constraints E-Prescribing Incentive Program Provider Conscience Clause Home Stockpiling of Antivirals National Ambient Air Quality for Lead

Client expense: $4,260,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

Flexible Spending Accounts Growth and Opportunities Act of 2007 - H.R. 298 The Breast Cancer Patient Protection Act of 2008 H.R. 758 Emergency Retiree Health Benefits Protection Act of 2007 - H.R. 1322 Paul Wellstone Mental Health and Addiction Equity Act 0f 2007 - H.R. 1424 Tax Equity for Health Plan Beneficiaries Act - H.R. 1820 Patient Protection and Innovative Biologic Medicines Act of 2007 - H.R. 1956 Promoting Health for Future Generations Act - H.R. 2639 Michelles Law H.R. 2851 Childrens Health and Medicare Act of 2007 - H.R. 3162 Healthy Americans Act - H.R. 3163 HSA Improvement and Expansion Act - H.R. 3234 Flexible Health Savings Act - H.R. 3306 Long-Term Care Affordability and Security Act of 2007 - H.R. 3363 Employment Non-Discrimination Act - H.R. 3685 Promoting Health Information Technology Act H.R. 3800 Defenders of Freedom Tax Relief Act of 2007/Heroes Earnings Assistance and Tax Relief Act of 2007-title as passed - H.R. 3997 Medicare Electronic Medication and Safety Protection (E-Meds) H.R. 4848 Mental Health Parity Extension Legislation - H.R. 4848 Technologies for Restoring Users Security and Trust in (TRUST) in Health Information Act of 2008 - H.R. 5442 Taxpayer Assistance and Simplification Act H.R. 5719 Promoting Health Information Technology Act of 2008 H.R. 6179 Retiree Health Account Act of 2008 H.R. 6288 Pension Protection Act ERISA Amendments H.R. 6143 ERISA Amendments HR 6142 Medicare Improvements for Patients and Providers Act of 2008 H.R. 6331 Patient-Controlled Health IT Act H.R. 6345 Protecting Records, Optimizing Treatment, and Easing Communication Through Healthcare Technology Act of 2008 The Pro (TECH) T Act of 2008 - H.R. 6357 Health Insurance Source of Injury Clarification Act of 2008 H.R. 6908 Health-e Information Technology Act of 2008 H.R. 6898 Senate Health Partnership Act - S. 325 Healthy Americans Act - S. 334 Genetic Information Nondiscrimination Act - 358 Mental Health Parity Act of 2007 - S. 558 Access to Life-Saving Medicine Act - S. 623 Universal Health Care Choice and Access Act - S. 1019 State-based Health Care Reform Act - S. 1169 Medicare Quality Enhancement Act - S. 1544 Tax Equity for Domestic Partner and Health Beneficiaries Act - S. 1556 Wired for Health Care Quality Act - S. 1693 Biologics Price Competition and Innovation Act - S. 1695 Healthy Workforce Act - S. 1753 Community Living Assistance Services and Supports Act (the CLASS Act) - S. 1758 Childrens Health Insurance Reauthorization Act - S. 1893 Long-Term Care Affordability and Security Act of 2007 - S. 2337 Medicare, Medicaid and SCHIP Extension Act of 2007 - S. 2499 Medicare Funding Warning Response Act of 2008 - S. 2662 Disability Savings Act - S. 2741 Medicare Improvements for Patients and Providers Act of 2008 - S. 3101 Preserving Access to Medicare Act of 2008 S. 3118 Comparative Effectiveness Research Act S. 3408

Client expense: $246,723 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of

H.R. 6179 - Promoting Health IT Act; HR 6357 PROTECHT ACT; S. 1693 Wired for Healthcare Quality Act.

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

NIH public access policy. HR 5442, TRUST in Health Information Act, provisions relating to privacy. HR 6179, Promoting Health Information Technology Act, provisions relating to privacy. HR 6357, PRO(TECH)T Act, provisions relating to privacy.

Client expense: $830,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6179, Pharmacy Benefit Records, All provisions S. 3327, Empowered at Home Act of 2008, All provisions S. 1693, Wired for Health Care Quality Act, All provisions S. 3001, Community Living Assistance Services and Support Act, All provisions

Client expense: $1,790,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), Natl Security Council (NSC), SENATE, State, Dept of (DOS), Treasury, Dept of, U.S. Trade Representative (USTR)

H.R. 3800, Promoting Health Information Technology Act S. 1456, Federal Employees Electronic Personal Health Records Act of 2007 S. 631, Remote Monitoring Access Act of 2007 S. 2408, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 H.R. 4296, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 S. 628, Critical Access to Health Information Technology Act of 2007 S. 1814, Health Information Privacy and Security Act S. 1915, Electronic Prescription Drug Act of 2007 S. 2029, Physician Payments Sunshine Act of 2007 H.R. 2991, Independent Health Record Trust Act of 2007 S. 1695, Biologics Price Competition and Innovation Act of 2007 S. 1693, Wired for Health Care Quality Act H.R. 1368, Personalized Health Care Quality Act S. 1783, Ten Steps to Transform Health Care in America Act S. 321, Fostering Independence Through Technology Act of 2007 H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication Through Healthcare Technology Act H.R. 6179, Promoting Health Information Technology Act H.R. 6898, Health-e Information Technology Act of 2008 S. 1456, The Federal Employees Electronic Personal Health Records Act of 2007

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Provisions of the Presidents FY2008 Budget and related appropriations legislation (S Con Res 70) related to implementation of the Medicare Advantage and Prescription Drug Programs, the provision of Medicare and Medicaid services and benefits to patients, incentives to promote electronic health records for all Americans, and prescription drug benefits. S 3101, and HR 6331, the Medicare Improvements for Patients and Providers Act of 2008. Supported provisions that prevent the 10.6% cut in Medicare physician payment that was called for in the November 27, 2007 CMS final rule implementing the Medicare physician fee schedule. The bill replaces the 10.6% cut with an increase through 2008, and extended the 1.0 floor on the geographic adjustor for physician work initially included in the Medicare Modernization Act of 2003 through 2008. S.2812, the Medicare Improvement Act of 2008 introduced by senator Kent Conrad. This legislation will expand the number of originating sites, the list of eligible practitioners, and provide an advisory committee to CMS and Congress on payment issues related to services provided via TeleHealth. The Physician Payment Sunshine Act, S. 2029, introduced by Senator Kohl with Senator Grassley to create accountability among physicians and the manufacturers of drugs and devices that physicians utilize and prescribe for their patients. This legislation would require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. The Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Grassley to mitigate current inequities in Medicare reimbursement, improve access to health services in rural and underserved areas, and will begin to close the gap between Medicare reimbursement and the cost of providing services in predominantly rural areas. The legislation establishes a 1.0 floor for physician work and practice expense adjustments. It also revises the work and practice expense formulas to reduce payment differences and more accurately compensate physicians in rural areas for their true practice costs. The bill also extends the five percent incentive payments for primary care and specialty physicians in scarcity areas. Marshfield Clinic nominated Dr. Douglas Reding for an open position on the Medicare Payment Advisory Commission, and sought the endorsement of the Wisconsin delegation, and other Senators and Representatives that serve on the Committees with jurisdiction over the Medicare program. Sustainable Growth Rate Medicares SGR mechanism unfairly links physician payment updates to factors unrelated to patients needs and the cost of providing patient care. Reform proposals include reimbursement updated on a market basket basis, removal of prescription drugs from the calculation of Medicare Part B costs, and rebasing Part B to reflect current rather than cumulative costs. Support for S.2785, the Save Medicare Access Act of 2008, introduced by Sen. Debbie Stabenow. It would avert the 10.6% cut to physician payments scheduled to take effect in July and the additional cut of 5% or more scheduled in January 09. Payments would continue at their current rate through the remainder of 2008 and then would rise by 1.8% in 2009. The current work GPCI floor and physician scarcity bonus would also be continued through the end of 2009. Pay-for Reporting and Performance Currently the prevailing methods of paying for health care in the US neither incent nor reward providing high quality care. The rising costs of care coupled with the increasing awareness of poor quality care have made clear the need for a transformation in the way health care is financed. In the fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the unanticipated, but now recognized effect of economically stimulating growth in the numbers of services provided by physicians. Medicare must implement quality based payments for physician services, and capture the data on performance measures utilizing available claims-based data recoverable through enhanced IT functions. In 2005, the Centers for Medicare and Medicaid Services (CMS) proposed the Physicians Voluntary Reporting Program (PVRP). In late 2006 CMS renamed PVRP the Physicians Quality Reporting Initiative. (PQRI) In the PQRI program CMS calls on physicians to report on evidence-based performance measures selected with input from the National Quality Forum, the Ambulatory Care Quality Alliance, and the National Committee for Quality Assurance, (NCQA). For reporting purposes physicians will utilize provisional G- Codes developed by CMS to indicate whether a patient received a service, did not receive the service, was not a eligible candidate to receive the service, or would not be considered a patient under the care of the physician at the time of the service. Marshfield Clinic has recommended that CMS allow medical groups to electronically report quality measures in an aggregated, periodic, statistically valid basis to PQRI; and re-focus the PQRI on high cost/high volume disease states. Marshfield Clinic supports a request for CMS authorization and funding for a multi-center demonstration project with access to vast data resources across multiple states. This proposed project will connect treatments with outcomes and develop quality metrics that reflect the realities of the care setting and the severity of the patients illness. Information Technology Under current law the capital and operating expenses of installing and maintaining an electronic medical record are assumed to be part of the overhead expense of a medical practice. Since no more than 5 10% of the physician population has installed EMRs, CMS measurement of current physician practice expenses reflect minimal expense associated with IT. Congress should provide incentives for EMR adoption, and should establish standards to facilitate the sharing and exchange of data. S. 1693, the Wired for Health Care Quality Act introduced by Senator Ted Kennedy (D-MA) and Michael Enzi (R-WY) - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. HR 6357, the Protecting Records, Optimizing Treatment and Easing Communications through Health Care Technology Act of 2008 is important legislation that promotes Health Information Technology and the protection of patients personal health information. HR 6357 codifies ONCHIT, provides grants and loans for HIT, but most importantly the bill creates new privacy and security provisions which require notification of breaches of PHI by covered entities and business associates. The bill also includes restrictions on certain disclosures of PHI allowing patients to request that their information not be released to health plans in certain circumstances. It also includes an impractical consent provision that requires additional patient consent if the PHI is utilized in operations, such as peer review, quality review, standard of care review, malpractice review, or best practices analysis. HR 6898 Health-e Information Technology Act of 2008, a bill that includes an estimated $4 billion in incentive payments to Medicare physicians and hospitals which demonstrate successful adoption and use of HIT once initial national technical standards are finalized. Support for privacy enforcement provisions. H.R.6179 the Promoting Health Information Technology Act of 2008 - provisions that encourage and facilitate the adoption of state reciprocity agreements for practitioner licensure in order to expedite the provision across state lines of telehealth services; and provisions that require the Centers of Medicare & Medicaid Services to make federally qualified health centers eligible to participate in demonstration projects related to health records and heath information technology. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Alternatives: CMS should administratively revise its measurements of the costs of practice to assure the validity and fairness of payments; a payment floor could be established for practice expense; or the present variation (.705 1.501) in practice expense could be channeled into a narrower corridor of adjustment. Payment Equity Before MMA 03, Medicares payments were geographically adjusted based upon erroneous assumptions about the cost of hiring and retaining physicians. Congress established a floor payment mechanism for the physician work component of Medicare payment for 04 07 to assure that physicians in low payment localities were compensated for their work at least at the national average payment amount. This payment floor should be extended indefinitely or geographic adjustment of work should be eliminated entirely. The Rural Medicare Equity Act of 2007 (S 498), introduced by Senator Russ Feingold, Amends title XVIII (Medicare) of the Social Security Act (SSA) to eliminate the geographic physician work adjustment factor from the geographic indices used to adjust payments under the physician fee schedule. Rep. Braley introduced HR 2827, the Medicare Equity and Accessibility Act, along with Rep. Adrian Smith (R-Nebraska). This bill will increase the Medicare Part B reimbursement rates in Iowa and other rural states, by making permanent the 1.0 floor on the Geographic Practice Indexes for Work and Practice Expense. Support for Medicare Rural Health Access Improvement Act, S 2786, introduced by Senator Chuck Grassley especially provisions that would extend the 1.0 work floor through December 31,2009, and would recognize the equality of physician work in all geographic areas and eliminate differing work index values by establishing a national value of 1.0, effective 2010. Also support provisions for physician practice expense that would establish a practice expense floor of 1.0 for 2009 by requiring the Secretary to increase the value of any practice expense geographic index that was below 1.0 to 1.0 for services furnished on or after January 1, 2009 and before January 1, 2010. Subsection (b) would reduce the geographic adjustment for practice expense to 50 percent of the current adjustment for employee wages and rent, effective 2010. Support for Rep. Ron Kinds concept of a not yet introduced MEDICARE EFFICIENCY BILL that would amend the CHAMP Act (H.R. 3162) 304 in whole, by establishing that the 5% bonus payment would be expanded to the top 10% of efficient counties; and a corresponding 5% efficiency penalty for physicians in the bottom 10% of efficient counties. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 - Public Law No: 108-173: Title II: Medicare Advantage -- (Sec. 211) Revises the payment system, requiring all plans to be paid at a rate at least as high as the rate for traditional Medicare fee-for-service plans. Makes change in budget neutrality for blended payments. Increases minimum percentage increase to national growth rate. Marshfield Clinic opposes reductions to Medicare Advantage payments in low payment states. Subtitle D: Additional Reforms - (Sec. 237) Provides that Federally Qualified Health Centers (FQHCs) will receive a wrap-around payment for the reasonable costs of care provided to Medicare managed care patients served at such centers. Raises reimbursements to FQHCs in order that when they are combined with MA payments and cost-sharing payments from beneficiaries they equal 100 percent of the reasonable costs of providing such services. Extends the safe harbor to include any remuneration between a FQHC (or entity controlled by an FQHC) and an MA organization. Title IV: Rural Provisions - Subtitle B: Provisions Relating to Part B Only - (Sec. 412) Directs the Secretary to increase the work geographic index to 1.00 for any locality for which such work geographic index is less than 1.00 for services furnished on or after January 1, 2004, and before January 1, 2007. Since this provision expires at the end of 2006 it must be extended or revised. See Tax Relief and Health Care Act provisions below (Sec. 413) Establishes a new five percent incentive payment program designed to reward both primary care and specialist care physicians for furnishing physicians' services on or after January 1, 2005, and before January 1, 2008 in physician scarcity areas. Directs the Secretary to pay the current law ten percent Health Professional Shortage Area (HPSA) incentive payment for services furnished in full county primary care geographic area HPSAs automatically rather than having the physician identify the health professional shortage area involved. Deficit Reduction Act (Section 5102) reduced reimbursements for multiple images on contiguous body parts in 2006; the DRA provision created in statute a basis for payment reductions on the imaging of contiguous body parts that CMS implemented through the rulemaking process in 2005; the DRA also requires that payment rates for imaging services delivered in physician offices do not exceed payment rates for identical imaging services delivered in hospital outpatient departments beginning in 2007. Clinic recommends that Congress repeal Section 5102, and direct MedPAC and CMS to conduct a comprehensive study of imaging and the geographic variation in services to determine where growth in the volume of imaging services is appropriate and develop workable solutions to control inappropriate imaging utilization. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic submitted a proposal for this demonstration and was selected by CMS to participate in the demonstration program, effective April 1, 2005. Marshfield Clinic supported CMS determination to extend this program, beyond its initial 3-year term. Also supports efforts to eliminate the 2% threshold for payments and the 5% limitation on payments. Regulatory clarification of Medicare anti-markup issues, and postponement of the effective date of CMS final rule regarding the applicability of the anti markup provisions with respect to: (1) the technical component of a purchased diagnostic test and (2) any anatomic pathology diagnostic testing services furnished in space that is utilized by a physician group practice as a "centralized building" for purposes of complying with the physician self-referral rules and does not qualify as a "same building".

Client expense: $110,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE

HR 2472, the Essential Oral Health Care Act HR 1781 and S. 739, Children's Dental Health Improvement Act HR 2371, Deamonte's Law S. 3064 Oral Health Initiative Act of 2008 HR 3186 and S. 1906, Meth Mouth Prevention and Community Recovery Act HR 3187 and S. 1907, Meth Mouth Correctional Costs HR 1108 and S. 625, Family Smoking Prevention and Tobacco Control Act HR 6331 Medicare Improvements for Patients and Providers Act of 2008 HR 976 and 3162, Children's Health and Medicare Protection Act of 2007 (SCHIP Reauthorization) S. 1893 Children's Health Insurance Program Reauthorization Act of 2007 (SCHIP Reauthorization) S.2723 and H.R.5549 Deamonte Driver Dental Care Access Improvement Act S. 3067 Dental Health Improvement Act of 2008 Secretarys Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 S.901 and HR 1343 Health Centers Renewal Act of 2007 HR 6357 Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008 or the PRO(TECH)T Act H.R. 2184, Enhanced Health Care Value for All Act of 2007 H.R. 3163 and S. 771, Child Nutrition Promotion and School Lunch Protection Act of 2007 S 1693 Wired for Health Care Quality Act S 334 Healthy Americans Act HR 5442 Technologies for Restoring Users' Security and Trust (TRUST) in Health Information Act HR 6331/S3101 Medicare Improvements for Patients and Providers Act HR 6898 Health-e Information Technology Act of 2008 S 628 Critical Access to Health Information Technology Act of 2007 S 980 Online Pharmacy Consumer Protection Act of 2007 S 1408 Health Information Technology Act of 2007 S 2408 Medicare Electronic Medication and Safety Protection (E-MEDS) Act S 2729 Ensuring the Future Physician Workforce Act of 2008 S 3072 Making Health Care More Affordable Act of 2008 HR 1467 10,000 Trained by 2010 Act HR 2377 Assisting Doctors to Obtain Proficient and Transmissible Health Information Technology (ADOPT HIT) Act of 2007 HR 6613 Improving Dental Access in Underserved Communities Act of 2008 HR 5885 Health Information Technology Promotion Act of 2008 HR 6179 Promoting Health Information Technology Act of 2008 S 1019 Universal Health Care Choice and Access Act S 1783 Ten Steps to Transform Health Care in America Act S 2105 A bill to provide for the establishment of the Federal Health Care Board. S. 3408 Comparative Effectiveness Research Act of 2008 H.R. 6845 Fair Copyright in Research Works Act of 2008

Client expense: $316,307 · Firm income: Not reported

Government targets: Air Force, Dept of, Army, Dept of (Other), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Indian Health Service, Internal Revenue Service (IRS), Natl Institute of Standards & Technology (NIST), Natl Institutes of Health (NIH), Navy, Dept of, SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, U.S. Marines, Veterans Affairs, Dept of (VA)

Issues pertaining to coverage and other health issues; H.R. 1424 Paul Wellstone Mental Health and Addiction Equity Act of 2007, Sec. 2, 3, 5 and 6 and all provisions relating to physician-owned hospitals as well as mental health parity; S. 558 Mental Health Parity Act of 2007, all provisions related to mental health parity; H.R. 1666 Health Care Price Transparency Promotion Act of 2007, all provisions to amend title XIX of the Social Security Act to provide for increased price transparency of hospital information and to provide for additional research on consumer information on charges and out-of-pocket costs; S. 866 Health Promotion First Act, all provisions pertaining to health promotion reearch and dissemination; S. 1893 Children's Health Insurance Program Reauthorization Act of 2007, all provisions related to this bill; H.R. 2851 and S. 400 Michelle's Law, all provisions to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to ensure that dependent students who take a medically necessary leave of absence do not lose health insurance coverage, and for other purposes; H.R. 5544 Patients and Public Health Partnership Act of 2008, all provisions to amend the Public Health Service Act to authorize a demonstration project for integrated health systems to expand access to primary and preventive care for the medically underserved, and for other purposes; H.R. 2606 340B Program Improvement and Integrity Act of 2007, all provisions to amend section 340B of the Public Health Service Act to revise and expand the drug discount program under that section to improve the provision of discounts on drug purchases for certain safety net providers; S. 1595 Critical Access Hospital Flexibility Act of 2007, all provisions to amend title XVIII of the Social Security Act to provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare program; S. 334 Healthy Americans Act, all provisions to provide affordable, guaranteed private health coverage that will make Americans healthier and can never be taken away; H.R. 5885Health Information Technology Promotion Act of 2008, to promote a better health information system; S. 2853, to amend title XVIII of the Social Security Act to remove the cap on disproportionate share adjustment percentages for certain rural hospitals; H.R. 5739 Physician Availability Act of 2008, to assure that the services of a non-emergency department physician are available to hospital patients 24 hours a day, seven days a week in all non-Federal hospitals with at least 100 licensed beds; H.R. 1174 Healthy Hospitals Act of 2007, to amend title XVIII of the Social Security Act to require public reporting of health care-associated infections data by hospitals and ambulatory surgical centers and to permit the Secretary of Health and Human Services to establish a pilot program to provide incentives to hospitals and ambulatory surgical centers to eliminate the rate of occurrence of such infections; H.R. 5942 National Trauma Center Stabilization Act of 2008, to ensure the continued and future availability of lifesaving trauma health care in the United States and to prevent further trauma center closures and downgrades by assisting trauma centers with uncompensated care costs, core mission services, emergency needs, and information technology; H.R. 6179 Promoting Health Information Technology Act of 2008, to encourage and enhance the adoption of interoperable health information technology to improve health care quality, reduce medical errors, and increase the efficiency of care; H.R. 6357 Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008' or the `PRO(TECH)T Act of 2008, to amend the Public Health Service Act to promote the adoption of health information technology, and for other purposes; H.R. 3014 Health Equity and Accountability Act of 2007, to improve the health of minority individuals, and for other purposes.

Client expense: $4,070,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Social Security Administration (SSA)

HR 1467 - 10,000 Trained by 2010 Act - in it's entirety, especially the workforce provisions HR 2406 - Healthcare Information Technology Enterprise Integration Act - health IT aspects with emphasis on terminology & classification HR 4105 - the Medicare Recovery Audit Contractor Program Moratorium Act of 2007 - Interested in the entire bill HR 3800 - the Promoting Health Information Technology Act - Interest in the entire legislation and its focus on health information technology S 1814 - Health Information Privacy and Security Act - Interest in the entire legislation and its focus on health information technology and privacy S 1693 - WIRED for Health Care Quality Act - Interest in the entire legislation and its focus on health information technology HR 493/S 358 - Genetic Information Nondiscrimination Act of 2007 - Interest in the entire legislation and its focus on privacy, nondiscrimination and health information HR 5442 - the TRUST Health Information Act of 2008 - Interest in the entire legislation and its focus on health information technology and privacy S 628 - The Critical Access to Health Information Technology Act - Interested in the legislation's provisions on ICD-10, HIPAA and standards S 695 - Allied Health Reinvestment Act - interested in the legilation's focus on growing the allied health workforce with includes health information management professionals HR 6357 - the The PROTECHT Act - Interest in the entire legislation and its focus on health information technology and privacy HR 6345 - the Patient-Controlled Health IT Act - interested in the legislation's provisions on health informaiton technology, personal health records and incentives HR 6179 - Interested in the legilation's provisions on health information technology and ICS-10. HR 2991 - the Independent Health Record Trust Act - Interested in the legislation's provisions on health record trusts (banks), personal health records and health information technology HR 2043 - the Medicaid Access Project through Health IT Act - interested in the bill's incentive programs for health IT through Medicaid HR 1952 - the National Health Information Infrastructure Incentive Act - Interested in the bill's HIT provisions and incentive provisions HR 1368 - the Personalized Health Information Act - Interested in the bill's entirety

Client expense: $30,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 3800, Promoting Health Information Technology Act S. 1456, Federal Employees Electronic Personal Health Records Act of 2007 S. 631, Remote Monitoring Access Act of 2007 S. 2408, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 H.R. 4296, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 S. 628, Critical Access to Health Information Technology Act of 2007 S. 1814, Health Information Privacy and Security Act S. 1915, Electronic Prescription Drug Act of 2007 S. 2029, Physician Payments Sunshine Act of 2007 H.R. 2991, Independent Health Record Trust Act of 2007 S. 1695, Biologics Price Competition and Innovation Act of 2007 S. 1693, Wired for Health Care Quality Act H.R. 1368, Personalized Health Care Quality Act S. 1783, Ten Steps to Transform Health Care in America Act S. 321, Fostering Independence Through Technology Act of 2007 H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication Through Healthcare Technology Act H.R. 6179, Promoting Health Information Technology Act

Client expense: $205,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Online Pharmacy Consumer Protection Act. S.980, H.R.6353. H.R. 3800, H.R.6179

Client expense: Not reported · Firm income: $50,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Flexible Spending Accounts Growth and Opportunities Act of 2007 - H.R. 298 Genetic Information Nondiscrimination Act - H.R. 493 Emergency Retiree Health Benefits Protection Act of 2007 - H.R. 1322 Paul Wellstone Mental Health and Addiction Equity Act 0f 2007 - H.R. 1424 Tax Equity for Health Plan Beneficiaries Act - H.R. 1820 Patient Protection and Innovative Biologic Medicines Act of 2007 - H.R. 1956 Promoting Health for Future Generations Act - H.R. 2639 Childrens Health and Medicare Act of 2007 - H.R. 3162 Healthy Americans Act - H.R. 3163 HSA Improvement and Expansion Act - H.R. 3234 Flexible Health Savings Act - H.R. 3306 Long-Term Care Affordability and Security Act of 2007 - H.R. 3363 Employment Non-Discrimination Act - H.R. 3685 Promoting Health Information Technology Act H.R. 3800 Defenders of Freedom Tax Relief Act of 2007/Heroes Earnings Assistance and Tax Relief Act of 2007-title as passed - H.R. 3997 Medicare Electronic Medication and Safety Protection (E-Meds) H.R. 4848 Mental Health Parity Extension Legislation - H.R. 4848 Technologies for Restoring Users Security and Trust in (TRUST) in Health Information Act of 2008 - H.R. 5442 Taxpayer Assistance and Simplification Act H.R. 5719 Promoting Health Information Technology Act of 2008 H.R. 6179 Retiree Health Account Act of 2008 H.R. 6288 Pension Protection Act ERISA Amendments H.R. 6143 ERISA Amendments HR 6142 Medicare Improvements for Patients and Providers Act of 2008 H.R. 6331 Patient-Controlled Health IT Act H.R. 6345 Protecting Records, Optimizing Treatment, and Easing Communication Through Healthcare Technology Act of 2008 The Pro (TECH) T Act of 2008 - H.R. 6357 Health Partnership Act - S. 325 Healthy Americans Act - S. 334 Genetic Information Nondiscrimination Act - 358 Mental Health Parity Act of 2007 - S. 558 Access to Life-Saving Medicine Act - S. 623 Universal Health Care Choice and Access Act - S. 1019 State-based Health Care Reform Act - S. 1169 Medicare Quality Enhancement Act - S. 1544 Tax Equity for Domestic Partner and Health Beneficiaries Act - S. 1556 Wired for Health Care Quality Act - S. 1693 Biologics Price Competition and Innovation Act - S. 1695 Healthy Workforce Act - S. 1753 Community Living Assistance Services and Supports Act (the CLASS Act) - S. 1758 Children's Health Insurance Reauthorization Act - S. 1893 Long-Term Care Affordability and Security Act of 2007 - S. 2337 Medicare, Medicaid and SCHIP Extension Act of 2007 - S. 2499 Medicare Funding Warning Response Act of 2008 - S. 2662 Disability Savings Act - S. 2741 Medicare Improvements for Patients and Providers Act of 2008 - S. 3101 Preserving Access to Medicare Act of 2008 - S. 3118 Regulatory - communication with covered federal officials on legislative issues: White House, Executive Office of the President - mental health parity (H.R. 1424/S. 558) & Health Savings Accounts (HSAs) (H.R 5719) Department of Labor (DOL) mental health parity (H.R. 1424/S. 558)

Client expense: $228,003 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, Treasury, Dept of, White House Office

H.R. 3800, Promoting Health Information Technology Act S. 1456, Federal Employees Electronic Personal Health Records Act of 2007 S. 631, Remote Monitoring Access Act of 2007 S. 2408, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 H.R. 4296, Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007 S. 628, Critical Access to Health Information Technology Act of 2007 S. 1814, Health Information Privacy and Security Act S. 1915, Electronic Prescription Drug Act of 2007 S. 2029, Physician Payments Sunshine Act of 2007 H.R. 2991, Independent Health Record Trust Act of 2007 S. 1695, Biologics Price Competition and Innovation Act of 2007 S. 1693, Wired for Health Care Quality Act H.R. 1368, Personalized Health Care Quality Act S. 1783, Ten Steps to Transform Health Care in America Act S. 321, Fostering Independence Through Technology Act of 2007 H.R. 6357, Protecting Records, Optimizing Treatment, and Easing Communication Through Healthcare Technology Act H.R. 6179, Promoting Health Information Technology Act

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

SCHIP Reauthorization support passage of and expansion to include oral health benefits for children, including HR.976, S.1893, HR.3162, and S.2499; S.1693, Wired for Health Care Quality Act adoption of; and interest in potential changes to HIPPA standards and coding provisions; HR.1781/S.739, Childrens Dental Health Improvement Act; and monitor general health care reform proposals; S. 625/HR. 1108, Family Smoking Prevention and Tobacco Control Act. S.739/HR.1781, Children's Dental Health Improvement Act. S.2723, Deamonte Driver Dental Care Access Improvement Act of 2008. HR. 6357, PRO(TECH)T Act of 2008. HR. 6179, Promoting Health Information Technology Act of 2008.

Client expense: Not reported · Firm income: $30,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6179 - Promoting Health IT Act; HR 6357 PROTECHT ACT; S. 1693 Wired for Healthcare Quality Act.

Client expense: Not reported · Firm income: $30,000

Government targets: Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, SENATE

NIH public access policy. HR 4296, Medicare Electronic Medication and Safety Protection (E-MEDS) Act, regarding all provisions. HR 5442, TRUST in Health Information Act, provisions relating to privacy, regarding all provisions. HR 6179, Promoting Health Information Technology Act, provisions relating to privacy. HR 6357, PRO(TECH)T Act, provisions relating to privacy.

Client expense: $920,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Electronic Health Records- Ensure legislation would not adversely impact pathologists and advance the implementation of health IT to modernize health records and improve the delivery of health care (H.R. 2626, the Comprehensive HealthCARE act of 2007, H.R. 6179, the Promoting Health Information Technology Act of 2008, S.1693 and H.R. 3800, the Wired for Health Care Quality Act)

Client expense: $239,500 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, SENATE