An Act to extend expiring provisions of the USA PATRIOT Improvement and Reauthorization Act of 2005 and Intelligence Reform and Terrorism Prevention Act of 2004 until February 28, 2011.

H.R. 1021/S.1548 - Access to America's Orthopedic Services Act of 2009: Musculoskeletal Disease and Condition Legislation to improve research, diagnosis, and treatment of musculoskeletal diseases, conditions, and injuries, to conduct a longitudinal study on aging, and for other purposes H.R. 3693 - Ensuring the Future Physician Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 3200 - America's Affordable Health Choices Act of 2009: provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 1678 - Mitigating the Impact of Uncompensated Service and Time Act of 2009: amend the Internal Revenue code of 1986 to allow a bad debt deduction to doctors to partially offset the cost of providing uncompensated care required to be provided under amendments made by the Emergency Medical Treatment and Labor Act. H.R. 3856 - Bone Health Promotion and Research Act of 2009: Amends the Public Health Service Act to: (1) authoirize the Secretary of Health and Human Services (HHS) to develop and implement a National Bone Health Program for the control, preention, and surveillance of osteoposoris and related bone diseases and to coordinate and carry out national education and outreach activities in support of such program; (2) authorize the Secretary to award grants to states and Indian tribes for comprehensive osteoporosis and related bone disease control and prevention programs; and (3) award grants or enter into cooperative agreements for the collection, analysis, and reporting of data on osteopososis and related bone diseases, including osteogenesis imperfecta and Paget's disease of the bone. Surgical Workforce Shortage Truth and Transparency .

Client expense: $331,937 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

H.R. 1021/S.1548 - Access to America's Orthopedic Services Act of 2009: Musculoskeletal Disease and Condition Legislation to improve research, diagnosis, and treatment of musculoskeletal diseases, conditions, and injuries, to conduct a longitudinal study on aging, and for other purposes H.R. 3693 - Ensuring the Future Physician Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 3200 - America's Affordable Health Choices Act of 2009: provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 1678 - Mitigating the Impact of Uncompensated Service and Time Act of 2009: amend the Internal Revenue code of 1986 to allow a bad debt deduction to doctors to partially offset the cost of providing uncompensated care required to be provided under amendments made by the Emergency Medical Treatment and Labor Act. H.R. 3856 - Bone Health Promotion and Research Act of 2009: Amends the Public Health Service Act to: (1) authoirize the Secretary of Health and Human Services (HHS) to develop and implement a National Bone Health Program for the control, preention, and surveillance of osteoposoris and related bone diseases and to coordinate and carry out national education and outreach activities in support of such program; (2) authorize the Secretary to award grants to states and Indian tribes for comprehensive osteoporosis and related bone disease control and prevention programs; and (3) award grants or enter into cooperative agreements for the collection, analysis, and reporting of data on osteopososis and related bone diseases, including osteogenesis imperfecta and Paget's disease of the bone. Surgical Workforce Shortage Truth and Transparency .

Client expense: $352,625 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 3693 - Ensuring the Future Physican Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3962 - The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 1031 - Health Information Technology Promotion Act of 2009 H.R. 1911 - American Recovery & Reinvestment Act (ARRA) Health Information Technology Meaningful Use Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage

Client expense: $352,625 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

HR 1 ARRA (increase in FMAP and moratorium on Medicaid Regulations). HR 2 SCHIP, HR 904/S 547 (Medicaid drug rebates). HR 684/S 330 (establish Government PDPs). S 266 (government run negotiation of drug prices in Medicare.) S 75 (to promote generic drugs in Medicare). S 677 (means-test Part B premiums). S 1832 (to regulate Part D plan prices). S 960 (Medicare Buy-In for age 55-64). HR 3961 ("Doc Fix"). S. 2128 (MM Fraud & Abuse) S 1776 (SGR).

Client expense: $1,641,400 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

See page 5 for a complete list of lobbying activities. HR 3961 - Medicare Physician Payment Reform Act of 2009 HR 4213 - American Jobs and Closing Tax Loopholes Act of 2010 HR 4691 - Temporary Extension Act of 2010 HR 4851 - Continuing Extension Act of 2010 HR 5295 - Healthcare Truth and Transparency Act of 2010 HR 5253 - Federal Research Public Access Act of 2010 CMS Medicare Physician Fee Schedule proposed rule, HHS Health Information Technology Meaningful Use, Medicare physician payment, National Healthcare Workforce Commission, Patient-Centered Outcomes Research Institute Board of Governors, HIT Meaningful Use, Independent Payment Advisory Board.

Client expense: $120,000 · Firm income: Not reported

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

See page 3 for a complete list of lobbying issues. HR 855/ S. 616 - Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies HR 2112/ S. 332 - Lung Cancer Mortality Reduction Act of 2009 HR 3590 - Patient Protection and Affordable Care Act HR 3961 - Medicare Physician Payment Reform Act of 2009 HR 4872 - Health Care and Education Reconciliation Act of 2010 HR 4213 - American Jobs and Closing Tax Loopholes Act of 2010 HR 4691 - Temporary Extension Act of 2010 HR 4851 - Continuing Extension Act of 2010 HR 4985 - Medicare Decisions Accountability Act of 2010 HR 5253 - Federal Research Public Access Act of 2010 HR 5295 - Healthcare Truth and Transparency Act of 2010 H. Con. Res. 202 - Celebrating the Goals and Ideals of the 20th Anniversary of The Society of Thoracic Surgeons National Database Health care reform, health care quality improvement; physician workforce; comparative effectiveness research; health information technology, National Healthcare Workforce Commission, Patient-Centered Outcomes Research Institute Board of Governors, HIT Meaningful Use, Independent Payment Advisory Board.

Client expense: $120,000 · Firm income: Not reported

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

See page 3 for a complete list of lobbying issues. HR 855/ S. 616 - Enhancing Safety in Medicine Utilizing Leading Advanced Simulation Technologies HR 2112/ S. 332 - Lung Cancer Mortality Reduction Act of 2009 HR 3590 - Patient Protection and Affordable Care Act HR 3961 - Medicare Physician Payment Reform Act of 2009 HR 4872 - Health Care and Education Reconciliation Act of 2010 HR 4213 - American Jobs and Closing Tax Loopholes Act of 2010 HR 4691 - Temporary Extension Act of 2010 HR 4851 - Continuing Extension Act of 2010 HR 4985 - Medicare Decisions Accountability Act of 2010 HR 5253 - Federal Research Public Access Act of 2010 HR 5295 - Healthcare Truth and Transparency Act of 2010 H. Con. Res. 202 - Celebrating the Goals and Ideals of the 20th Anniversary of The Society of Thoracic Surgeons National Database Health care reform, health care quality improvement; physician workforce; comparative effectiveness research; health information technology, National Healthcare Workforce Commission, Patient-Centered Outcomes Research Institute Board of Governors, HIT Meaningful Use, Independent Payment Advisory Board.

Client expense: $120,000 · Firm income: Not reported

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

See page 5 for a complete list of lobbying activities. HR 3961 - Medicare Physician Payment Reform Act of 2009 HR 4213 - American Jobs and Closing Tax Loopholes Act of 2010 HR 4691 - Temporary Extension Act of 2010 HR 4851 - Continuing Extension Act of 2010 HR 5295 - Healthcare Truth and Transparency Act of 2010 HR 5253 - Federal Research Public Access Act of 2010 CMS Medicare Physician Fee Schedule proposed rule, HHS Health Information Technology Meaningful Use, Medicare physician payment, National Healthcare Workforce Commission, Patient-Centered Outcomes Research Institute Board of Governors, HIT Meaningful Use, Independent Payment Advisory Board.

Client expense: $120,000 · Firm income: Not reported

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

Medicare reimbursement for imaging services and certification of imaging technicians; health care reform legislation as it pertains to medical imaging; S 1679/HR 3200; HR 3590; HR 3780; HR 3961; issues related to nuclear medicine reimbursement under the Physician Fee Schedule; HR 3652, CARE Act.

Client expense: $130,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Nuclear Regulatory Commission (NRC), Office of Management & Budget (OMB), SENATE

Medicare reimbursement for imaging services and certification of imaging technicians; health care reform as it pertains to imaging; S 1679/HR 3200, America's Affordable Health Choices Act of 2009; HR 3590, The Patient Protection and Affordable Health Care Act; HR 3780, Healthcare Reform Provisions; HR 3961 Medicare Physician Payment Reform Act, issues related to nuclear medicine reimbursement under the physician Fee Schedule; HR 3652, the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Act of 2009.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

Medicare reimbursement for imaging services and certification of imaging technicians; health care reform as it pertains to imaging; S 1679/HR 3200, America's Affordable Health Choices Act of 2009; HR 3590, The Patient Protection and Affordable Health Care Act; HR 3780, Healthcare Reform Provisions; HR 3961 Medicare Physician Payment Reform Act, issues related to nuclear medicine reimbursement under the physician Fee Schedule; HR 3652, the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Act of 2009.

Client expense: $120,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill 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 and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services;. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines on governance which were intepreted to require that each organization with a CCN have a separate governing body, medical staff, etc. in order to be accredited ; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs. Sen. Stabenow and Sen. Murkoswki, Rep. Crowley and Rep. Sessions letter to CMS asking to reevaluate the proposed IPPS regulations that will hit hospital payments in FY 2011; Rep. Pomeroy and Rep. Moran letter to CMS, regarding concerns of the proposed Medicare OPPS regulation for FY 2011 does not show continued access to full range of outpatient therapeutic services for small, rural & CAH hospitals; Discussion with CMS about implementation of the self-referral disclosure protocol; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 or Physician Payment and Therapy Relief Act of 2010, to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs.

Client expense: $5,390,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

H.R.1586, FAA Air Transportation Modernization and Safety Improvement Act, Preventing reduction in Medicaid's payments to states H.R. 3961, Statutory Pay-As-You-Go Act of 2009, Postponing the Medicare payment cuts until September 30, 2010 H.R. 3962, Affordable Health Care for America Act, Postponing the Medicare payment cut until November 30, 2919 and providing a 2.2 percent update in payments H.R. 5297, Small Business Jobs and Credit Act of 2010, Minimizing effect of requirement to file Form 1099 and preventing loss of preventive health funds H.R. 5690, To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system, and for other purposes, AAFP policy supports medical liability reforms S. 3307, Healthy, Hunger-Free Kids Act, Increasing funding for federal nutrition programs S.3686 - An original bill making appropriations for the Department of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2011, and for other purposes, Title VII health professions grants for primary care funding, National Health Service Corps, National Health Care Workforce Commissions, Health Care for All, medical student debt relief, development grants authorized by health reform promoting a new model of training for primary care physicians in health centers, AHRQ comparative effectiveness research, Health Information Technology and practice enhancement support, Patient Centered Medical Home, and providing a 2.2 percent update in payments No Bill Number, Accountable Care Organizations, Proposing ways to make primary care practices central to ACOs, Caution re exclusions, patient freedom of choice; data; risk; adjustment No Bill Number, Graduate Medical Education regulations, GME cost provisions that were in the physician payment rule, workforce development and GME modernization No Bill Number, Patient Visitation Rights regulations, Recommending increased equality in visitation rights for legal couples No Bill Number, Home Health Certification regulations, Recommending improvements to face to face requirement for home health certification No Bill Number, Payment Policies under the Physician Fee Schedule and other revisions to Part B for CY 2011, Medicare fee schedule for 2011 No Bill Number, Health Insurance Exchanges, Participating in HHS forum on Health Insurance Exchanges No Bill Number, Coverage of Preventive Services, Commenting on regulation requiring some health plans to cover preventive health services No Bill Number, New clinical preventative health topics, Nominations to the USPS task force committee No Bill Number, Health Information Technology, Using HITECH Act to spur adoption and use of Health Information Technology in small practices No Bill Number, Funding for Family Medicine priorities for 2011, Increasing funding for health professions programs in the next budget No Bill Number, Discussions with HRSA on Title VII health professions grant programs, HRSA health professions programs No Bill Number, Briefings on Antitrust and Accountable Care Organizations/integrative care, ACOs structured on a primary care foundation and antitrust protection for family physicians No Bill Number, Teaching health centers, Securing HRSA GME payment for family medicine residency training programs No Bill Number, Primary Care Health Professions promotion scholarship programs, loan repayment, Title VII, Graduate Medical Education payment reforms. Expand Family Medicine workforce, medical student debt relief, GME modernization to improve financing of family medicine of family medicine education and training No Bill Number, Inquiries about nominations for appointment to National Workforce Commission, Policy calls for this commission No Bill Number, Geographic payment variation under Medicare, Input to IOM study on value modifier No Bill Number, Patient Centered Outcomes Research, To educate agencies about the importance of including FPS on the PCORi No Bill Number, Medicare Physician Payment Reform, Preventing Medicare Physician payment cuts No Bill Number, Patient Centered Primary Care Collaborative, Medical Home and Health Reform No Bill Number, Herndon alliance, Health Care Reform No Bill Number, Accountable Care Organization Regs, Urging agencies to base ACOs on primary care practices No Bill Number, CMS Prep Call, For meeting with the Administrator, actually meeting with the Administrator, Dr. Don Berwick No Bill Number, Workforce and NIH funding

Client expense: $1,105,409 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

H.R. 3961, Statutory Pay-As-You-Go Act of 2009, Postponing the Medicare payment cuts until September 30, 2010 H.R. 3962, Affordable Health Care for America Act, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act, Postponing Medicare payment cut until November 30, 2010and providing a 2.2 percent update in payments S 1628, Rural Physician Pipeline Act of 2009, health professions training funds and rural health needs S.3686 - An original bill making appropriations for the Department of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2011, and for other purposes, Title VII health professions grants for primary care funding, National Health Service Corps, National Health Care Workforce Commissions, Health Care for All, medical student debt relief, development grants authorized by health reform promoting a new model of training for primary care physicians in health centers, AHRQ comparative effectiveness research, Health Information Technology and practice enhancement support, Patient Centered Medical Home, and providing a 2.2 percent update in payments No Bill Number, Briefings on Antitrust and Accountable Care Organizations/integrative care, ACOs structured on a primary care foundation and antitrust protection for family physicians No Bill Number, Teaching health centers, Securing HRSA GME payment for family medicine residency training programs No Bill Number, Primary Care Health Professions promotion scholarship programs, loan repayment, Title VII, Graduate Medical Education payment reforms. Expand Family Medicine workforce, medical student debt relief, GME modernization to improve financing of family medicine of family medicine education and training No Bill Number, Medicare Physician payment reform/Sustainable Growth Rate patch, Prevent Medicare physician payment cut without cutting health reform as "pay for" No Bill Number, Primary Care Workforce Grants announcement, Title VII primary care training grants No Bill Number, Accountable Care Organizations regulations, Proposing ways to make primary care practices central to ACOs, Caution re exclusions, patient freedom of choice; data; risk adjustments No Bill Number, Payment Policies under the Physician Fee Schedule and other revisions to Part B for CY 2011, Medicare fee schedule for 2011 H.R.1586, FAA Air Transportation Modernization and Safety Improvement Act, Preventing reduction in Medicaid's payments to states No Bill Number, Geographic payment variation under Medicare, Input to IOM study on value modifier No Bill Number, Graduate Medical Education regulations, GME cost provisions that were in the physician payment rule, workforce development and GME modernization No Bill Number, Discussions with HRSA on Title VII health professions grant programs No Bill Number, Workforce and NIH funding No Bill Number, Accountable Care Organizations regulations, Proposing ways to make primary care practices central to ACOs No Bill Number, Communicating with CMS on Medicare Issues No Bill Number, CMS Prep Call, For meeting with the Administrator, actually meeting with the Administrator, Dr. Don Berwick

Client expense: $1,105,409 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

H.R. 2697 - Optometric Equity in Medicaid Act of 2009, Federal mandates for Medicaid of optometric medical & surgical coverage, all sections SGR - H.R. 3961, Medicare Physician Payment Reform Act, all sections H.R. 3590 Patient Protection and Affordable Care Act H.R. 3962, Affordable Health Care for America Act H.R. 4371, to amend Title XVIII of the Social Security Act, all sections H. Res. 1226 /S. Res. 557, Resolution recognizing 25th Anniversary of Eye Care America Program H.R. 577/S.259, Vision Care for Kids Act of 2009, provide vision care to children, and for other purposes, all sections H.R. 3590, Patient Protection and Affordable Care Act Vision and Eye Health Promotion Act (draft) H.R. 5295, Truth in Advertising Act H.R. 3763 /S.3416, Red Flag Guidelines Legislation H.R. 3652/S.3737, Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Act

Client expense: $270,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

HR 1884, National Health Service Corps Improvement Act of 2009, all sections relating to vision. HR 2350, Preserving Patient Access to Primary Care Act, all sections relating to vision. HR 2697, To amend title XIX of the Social Security Act to require Medicaid coverage of professional services of optometrists that are otherwise covered when furnished by a physician, all sections relating to vision.. HR 3961, Medicare Physician Payment Reform Act of 2009, all sections relating to vision. HR 3962, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, all sections relating to vision. HR 4371, To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services, all sections relating to vision. HR 4994, Medicare and Medicaid Extenders Act of 2010, all sections relating to vision. HR 5295, Healthcare Truth and Transparency Act of 2010, all sections relating to vision. HR 5424, Reform Americans Can Afford Act of 2010, all sections relating to vision. HR 6376, To amend title XVIII of the Social Security Act with respect to physician supervision of therapeutic hospital outpatient service, all sections relating to vision. S. 259, Vision Care for Kids Act of 2009, all sections relating to vision.

Client expense: $280,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3961, Medicare Physician Payment Reform Act of 2009, all sections relating to vision. HR 4994. Medicare and Medicaid Extenders Act of 2010, all sections relating to vision.

Client expense: $280,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 444 - The 340B Program Improvement and Integrity Act of 2009 S. 1239 - The 340B Program Improvement and Integrity Act of 2009 S. 973, H.R. 2251 - Resident Physician Shortage Reduction Act S. 1776 - The Medicare Physician Fairness Act of 2009 H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4995 - Medicare and Medicaid Extenders Act of 2010

Client expense: $70,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Reimbursement; Sustainable Growth Rate/Physician Fee Schedule Fix; Temporary Increase and Reform of the Federal Medical Assistance Percentage (FMAP); Medicare Advantage Reimbursement; Indirect Medical Education Issues; Hospital Charity Care Issues; Medicare Health Technology Adoption Incentives; Health Information Technology; H.R. 3961, Medicare Physician Payment Reform Act; H.R. 4872, the Health Care and Education Reconciliation Act of 2010; the Patient Protection & Affordable Care Act (P.L. 111-148); issues related to accountable care organizations; FY 2011 Inpatient Prospective Payment System.

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

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

H.R. 1384 - To amend part B of title XVIII of the Social Security Act to remove limiting charges under the Medicare Program for non-participating physicians with beneficiary notice and to preempt State laws that prohibit balance billing. H.R. 3962 - Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - To amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration. S. 1776 - A bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes. H.R. 4994 - Medicare and Medicaid Extenders Act of 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

reduction of the maximum federal estate tax rate and ultimate elimination of federal estate, gift and generation-skipping taxes; specific bills include H.Con.Res.85, H.R.436, H.R.498, H.R.2023, H.R.2920, H.R.3463, H.R.3524, H.R.3905, H.R.3961, H.R.4154, H.R.4849, H.R. 4853, H.R.4899, H.R.5486, S.Con.Res.13, S.722, S.2784

Client expense: Not reported · Firm income: $90,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. Medicare Physician Fee Schedule - AAGP urges Congress to replace the current Medicare reimbursement formula with one that more accurately reflects the volume and intensity of services furnished to Medicare beneficiaries and to take action to avert future cuts in Medicare payments to physicians and other health care providers. Support H.R. 3961, the "Medicare Physcian Payment Reform Act of 2009," to permanently repeal the sustainable growth rate (SGR) formula that calls for annual cuts in Medicare physician payments and replace it with a new payment system. Support S. 1776, the "Medicare Physician Fairness Act of 2009," to eliminate Medicare's sustainable growth rate formula. 2. H. R. 1415, the "Medicaid Emergency Psychiatric Care Demonstration Project Act," a bill to provide for a demonstration project regarding Medicaid reimbursement for stabilization of emergency medical conditions by non-publicly owned or operated institutions for mental disorders. Support all provisions. 3. S. 647, the "Nursing Home Transparency and Improvement Act of 2009," to increase public transparency of nursing home owners and operators, including nursing home chains, by requiring nursing homes to disclose the corporate entities that own them and the affiliated entities that operate, manage or control them. Support all provisions. 4. Oppose any exclusion of specific medical specialties from primary care bonuses under Medicare. 5. Support bonus payments under Medicare for geriatric specialists. 6. Support extension of 5% increase in Medicare payment for psychotherapy services. 7. Support elimination of the Medicare disabililty waiting period. 8. Support S. 2908, support for family caregivers under Medicare and Medicaid. 9. Support legislative efforts to avert or repeal the elimination of the billing codes for consultation services, as called for in the Centers for Medicare and Medicaid Services final rule on the calendar year 2010 Medicare Physician Fee Schedule. (H.R. 3590). 10. S. 3028 and H.R. 6143, to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program. Support all provisions. 11. Support extension of Medicaid assistance to states that was included as part of the American Recovery and Reinvestment Act (ARRA). 12. Support H.R. 3962, the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010"; support provision to prevent the 21 percent cut in Medicare payments to physicians through November 30, 2010, and give physicians a 2.2 percent increase in Medicare reimbursement. 13. Support H. R. 5712, to avert for one month a 23 percent cut in Medicare physician reimbursement rates that was scheduled to take effect on December 1, 2010. 14. Support H. R. 4994, to prevent a 25 percent cut in Medicare physician pay rates that was due to take effect on January 1, 2011, and extend current payment rates through December 31, 2011.

Client expense: $20,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. Health Coverage: Guarantee all Americans access to health coverage; create tax credits to subsidize coverage for low income persons to buy into the Federal Employees Health Benefits Plan (FEHBP); create new options for small businesses to buy into group coverage based on the FEHBP; expand Medicaid and CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP program with additional funding to assure adequate coverage of all eligible children; target increases in Medicare payments for primary care physicians; target incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home; provide subsidies for newly unemployed workers to obtain COBRA coverage; provide temporary Medicaid coverage to laid-off workers; increase funding for community health centers; provide substantial funds for the Prevention and Wellness Fund to fight preventable chronic diseases; support healthcare research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and CHIP; support existing work being done by public and private sector partnerships on HIT policy, standards and certification; H.R. 1, the American Recovery and Reinvestment Act. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646). Healthcare in the FY2010 and FY2011 Budget: Account for the costs of preventing Medicare physician pay cuts under the Sustainable Growth Rate formula; address the negative impact of Medicare payment cuts on small physician practices; support the concept of dedicating funding for health care reform; support funding for physicians to acquire health information technology (HIT) to be used in a meaningful way; note concerns about penalties that would reduce baseline payments to physicians not using certified HIT systems beginning in 2015; support a policy reserve fund for physician payment reform, as reported out of the House Committee on the Budget, including the language to ensure primary care receives appropriate compensation. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268, provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $240,589 · Firm income: Not reported

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. Health Coverage: Guarantee all Americans access to health coverage; create tax credits to subsidize coverage for low income persons to buy into the Federal Employees Health Benefits Plan (FEHBP); create new options for small businesses to buy into group coverage based on the FEHBP; expand Medicaid and CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP program with additional funding to assure adequate coverage of all eligible children; target increases in Medicare payments for primary care physicians; target incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home; provide subsidies for newly unemployed workers to obtain COBRA coverage; provide temporary Medicaid coverage to laid-off workers; increase funding for community health centers; provide substantial funds for the Prevention and Wellness Fund to fight preventable chronic diseases; support healthcare research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and CHIP; support existing work being done by public and private sector partnerships on HIT policy, standards and certification; H.R. 1, the American Recovery and Reinvestment Act. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicare's reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for the Medicare physician payments at least through 2011; The Medicare and Medicaid Extenders Act of 2010, H.R. 4994, prevents the 25 percent physician payment cuts under Medicare, brought on by the flawed Sustainable Growth Rate (SGR) formula, from going into effect on Jan.1, 2011, and continues current rates through Dec. 31, 2011. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646). Healthcare in the FY2010 and FY2011 Budget: Account for the costs of preventing Medicare physician pay cuts under the Sustainable Growth Rate formula; address the negative impact of Medicare payment cuts on small physician practices; support the concept of dedicating funding for health care reform; support funding for physicians to acquire health information technology (HIT) to be used in a meaningful way; note concerns about penalties that would reduce baseline payments to physicians not using certified HIT systems beginning in 2015; support a policy reserve fund for physician payment reform, as reported out of the House Committee on the Budget, including the language to ensure primary care receives appropriate compensation. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268, provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $135,939 · Firm income: Not reported

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

Medicare Reimbursement; Sustainable Growth Rate/Physician Fee Schedule Fix; Temporary Increase and Reform of the Federal Medical Assistance Percentage (FMAP); Medicare Advantage Reimbursement; Indirect Medical Education Issues; Hospital Charity Care Issues; Medicare Health Technology Adoption Incentives; Health Information Technology; H.R. 3961, Medicare Physician Payment Reform Act; H.R. 4872, the Health Care and Education Reconciliation Act of 2010; the Patient Protection & Affordable Care Act (P.L. 111-148); issues related to accountable care organizations; FY 2011 Inpatient Prospective Payment System.

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

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

Monitor legislation and advise client as to how it affects them. Labor, HHS, & Education Appropriations FY 2011 C.R, Medical Assistance Percentages (FMAP) program, CAP IME, Patient Protection and Affordable Care Act (H.R.3590), Affordable Health Choices Act (S.1679), America's Healthy Future Act of 2009 (S.1796), Reconciliation Act of 2010 (H.R.4872). Electronic Health Record Incentives for Multi Campus Hospitals Act of 2010 (S. 3078, H.R. 6072), Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. ; 42 CFR 413.79; Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gain sharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); Medicare 72-hour payment window limitation (H.R.4213); HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S. 3708)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Transportation, Dept of (DOT)

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590, P.L. 111-148)); and Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), P.L. 111-152); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); Medicare 72-hour payment window limitation (H.R.4213); HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S. 3708); the "coding offset" in the proposed and final Medicare inpatient prospective payment system rule for 2011 (CMS-1498); the Medicare and Medicaid Extenders Act (H.R. 4994, later P.L. 111-309); and cancer hospital Medicare payment issues. Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847, H.R.4213) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Healthcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590, P.L. 111-148), and the Health and Education Affordability Reconciliation Act of 2010 (H.R. 4872, P.L. 111-152)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S.3708); and the Medicare and Medicaid Extenders Act (H.R. 4994, later P.L. 111-309).

Client expense: $380,000 · Firm income: Not reported

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

Medicare reimbursement Iowa hospitals; CMS interagency transfers; IME issues; Medicaid reimbursement issues; DHS; GME (dental and others); Medicare and Medicaid reimbursement issues as related to academic teaching hospitals; CMS rules as they relate to physician and hospital payments, 340 B Drug Pricing Program; H.R. 5613 Protecting the Medical Safety Act of 2008 Federal Medical Assistance Percentages; Statutory Pay As You Go Act of 2009 (H.R. 3961), Health Care Reform (H.R. 3590)

Client expense: $88,684 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), Transportation, Dept of (DOT)

H.R. 1384 - To amend part B of title XVIII of the Social Security Act to remove limiting charges under the Medicare Program for non-participating physicians with beneficiary notice and to preempt State laws that prohibit balance billing. H.R. 3962 - Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - To amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration. S. 1776 - A bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes. H.R. 4994 - Medicare and Medicaid Extenders Act of 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1 American Recovery and Reinvestment Act (increase FMAP, and moratorium on Medicaid regulations) HR 2, SCHIP. HR 904/S 547 (Medicaid drug rebates) HR 684/S. 330 (to establish government-run PDP) S. 266 (government run negotiation of drug prices in Medicare) S. 75 (to promote generic drugs in Medicare). S. 677 (to means-test Part B Premiums). S. 1832 (to regulate Part D plan prices). S.960 (Medicare Buy in); HR 3961 ("Doc Fix"); S. 2128 (MM Fraud & Abuse); S. 1776 (SGR). HR 3590/HR 48

Client expense: $998,150 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

Medicare reimbursement for imaging services and certification of imaging technicians; health care reform legislation as it pertains to medical imaging; S1679/JR3200; HR3590; HR3780; HR3961; issues related to nuclear medicine reimbursement under the Physician Fee Schedule; HR3652 CARE Act

Client expense: Not reported · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Nuclear Regulatory Commission (NRC), Office of Management & Budget (OMB), SENATE

H.R. 1021/S.1548 - Access to America's Orthopedic Services Act of 2009: Musculoskeletal Disease and Condition Legislation to improve research, diagnosis, and treatment of musculoskeletal diseases, conditions, and injuries, to conduct a longitudinal study on aging, and for other purposes H.R. 3693 - Ensuring the Future Physician Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 3200 - America's Affordable Health Choices Act of 2009: provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. H.R. 1678 - Mitigating the Impact of Uncompensated Service and Time Act of 2009: amend the Internal Revenue code of 1986 to allow a bad debt deduction to doctors to partially offset the cost of providing uncompensated care required to be provided under amendments made by the Emergency Medical Treatment and Labor Act. H.R. 3856 - Bone Health Promotion and Research Act of 2009: Amends the Public Health Service Act to: (1) authoirize the Secretary of Health and Human Services (HHS) to develop and implement a National Bone Health Program for the control, preention, and surveillance of osteoposoris and related bone diseases and to coordinate and carry out national education and outreach activities in support of such program; (2) authorize the Secretary to award grants to states and Indian tribes for comprehensive osteoporosis and related bone disease control and prevention programs; and (3) award grants or enter into cooperative agreements for the collection, analysis, and reporting of data on osteopososis and related bone diseases, including osteogenesis imperfecta and Paget's disease of the bone. Surgical Workforce Shortage Truth and Transparency .

Client expense: $573,687 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

H.R. 1829/S.950 - Medicare Patient Access to Physical Therapists Act of 2009: prevent direct access to physical therapists in order to avoid unnecessary and overuse of therapy services. H.R. 3693 - Ensuring the Future Physican Workforce Act of 2009 H.R. 4851 - Continuing Extension Act of 2010 H.J. RES. 45 - Increasing the statutory limit on the public debt H.R. 3962 - Affordable Health Care for America Act H.R. 3962 - The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R. 3961 - Medicare Physician Payment Reform Act of 2009 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4872 - Health Care and Education Reconciliation Act of 2010 H.R. 3590 - Patient Protection and Affordable Care Act H.R. 1031 - Health Information Technology Promotion Act of 2009 H.R. 1911 - American Recovery & Reinvestment Act (ARRA) Health Information Technology Meaningful Use Stark II - Physician Ban on Self-Referral and Other Fraud & Abuse: ensure that Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage

Client expense: $573,687 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE

H.R. 444 - The 340B Program Improvement and Integrity Act of 2009 S. 1239 - The 340B Program Improvement and Integrity Act of 2009 S. 973, H.R. 2251 - Resident Physician Shortage Reduction Act S. 1776 - The Medicare Physician Fairness Act of 2009 H.R. 3961 - Medicare Physician Payment Reform Act of 2009

Client expense: $80,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

reduction of the maximum federal estate tax rate and ultimate elimination of federal estate, gift and generation-skipping taxes; specific bills include H.Con.Res.85, H.R.436, H.R.498, H.R.2023, H.R.2920, H.R.3463, H.R.3524, H.R.3905, H.R.3961, H.R.4154, H.R.4849, H.R.4899, H.R.5486, S.Con.Res.13, S.722, S.2784

Client expense: Not reported · Firm income: $70,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1586, FAA Air Transportation Modernization and Safety Improvement Act, Preventing reduction in Medicaid's payments to states H.R. 3961, Statutory Pay-As-You-Go Act of 2009, Postponing the Medicare payment cuts until September 30, 2010 H.R. 3962, Affordable Health Care for America Act, Postponing the Medicare payment cut until November 30, 2919 and providing a 2.2 percent update in payments H.R. 5297, Small Business Jobs and Credit Act of 2010, Minimizing effect of requirement to file Form 1099 and preventing loss of preventive health funds H.R. 5690, To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system, and for other purposes, AAFP policy supports medical liability reforms S. 3307, Healthy, Hunger-Free Kids Act, Increasing funding for federal nutrition programs S.3686 - An original bill making appropriations for the Department of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2011, and for other purposes, Title VII health professions grants for primary care funding, National Health Service Corps, National Health Care Workforce Commissions, Health Care for All, medical student debt relief, development grants authorized by health reform promoting a new model of training for primary care physicians in health centers, AHRQ comparative effectiveness research, Health Information Technology and practice enhancement support, Patient Centered Medical Home, and providing a 2.2 percent update in payments No Bill Number, Accountable Care Organizations, Proposing ways to make primary care practices central to ACOs, Caution re exclusions, patient freedom of choice; data; risk; adjustment No Bill Number, Graduate Medical Education regulations, GME cost provisions that were in the physician payment rule, workforce development and GME modernization No Bill Number, Patient Visitation Rights regulations, Recommending increased equality in visitation rights for legal couples No Bill Number, Home Health Certification regulations, Recommending improvements to face to face requirement for home health certification No Bill Number, Payment Policies under the Physician Fee Schedule and other revisions to Part B for CY 2011, Medicare fee schedule for 2011 No Bill Number, Health Insurance Exchanges, Participating in HHS forum on Health Insurance Exchanges No Bill Number, Coverage of Preventive Services, Commenting on regulation requiring some health plans to cover preventive health services No Bill Number, New clinical preventative health topics, Nominations to the USPS task force committee No Bill Number, Health Information Technology, Using HITECH Act to spur adoption and use of Health Information Technology in small practices No Bill Number, Funding for Family Medicine priorities for 2011, Increasing funding for health professions programs in the next budget No Bill Number, Discussions with HRSA on Title VII health professions grant programs, HRSA health professions programs No Bill Number, Briefings on Antitrust and Accountable Care Organizations/integrative care, ACOs structured on a primary care foundation and antitrust protection for family physicians No Bill Number, Teaching health centers, Securing HRSA GME payment for family medicine residency training programs No Bill Number, Primary Care Health Professions promotion scholarship programs, loan repayment, Title VII, Graduate Medical Education payment reforms. Expand Family Medicine workforce, medical student debt relief, GME modernization to improve financing of family medicine of family medicine education and training No Bill Number, Inquiries about nominations for appointment to National Workforce Commission, Policy calls for this commission No Bill Number, Geographic payment variation under Medicare, Input to IOM study on value modifier No Bill Number, Patient Centered Outcomes Research, To educate agencies about the importance of including FPS on the PCORi No Bill Number, Medicare Physician Payment Reform, Preventing Medicare Physician payment cuts No Bill Number, Patient Centered Primary Care Collaborative, Medical Home and Health Reform No Bill Number, Herndon alliance, Health Care Reform No Bill Number, Accountable Care Organization Regs, Urging agencies to base ACOs on primary care practices No Bill Number, CMS Prep Call, For meeting with the Administrator, actually meeting with the Administrator, Dr. Don Berwick No Bill Number, Workforce and NIH funding

Client expense: $2,774,319 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

H.R. 3961, Statutory Pay-As-You-Go Act of 2009, Postponing the Medicare payment cuts until September 30, 2010 H.R. 3962, Affordable Health Care for America Act, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act, Postponing Medicare payment cut until November 30, 2010and providing a 2.2 percent update in payments S 1628, Rural Physician Pipeline Act of 2009, health professions training funds and rural health needs S.3686 - An original bill making appropriations for the Department of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2011, and for other purposes, Title VII health professions grants for primary care funding, National Health Service Corps, National Health Care Workforce Commissions, Health Care for All, medical student debt relief, development grants authorized by health reform promoting a new model of training for primary care physicians in health centers, AHRQ comparative effectiveness research, Health Information Technology and practice enhancement support, Patient Centered Medical Home, and providing a 2.2 percent update in payments No Bill Number, Briefings on Antitrust and Accountable Care Organizations/integrative care, ACOs structured on a primary care foundation and antitrust protection for family physicians No Bill Number, Teaching health centers, Securing HRSA GME payment for family medicine residency training programs No Bill Number, Primary Care Health Professions promotion scholarship programs, loan repayment, Title VII, Graduate Medical Education payment reforms. Expand Family Medicine workforce, medical student debt relief, GME modernization to improve financing of family medicine of family medicine education and training No Bill Number, Medicare Physician payment reform/Sustainable Growth Rate patch, Prevent Medicare physician payment cut without cutting health reform as "pay for" No Bill Number, Primary Care Workforce Grants announcement, Title VII primary care training grants No Bill Number, Accountable Care Organizations regulations, Proposing ways to make primary care practices central to ACOs, Caution re exclusions, patient freedom of choice; data; risk adjustments No Bill Number, Payment Policies under the Physician Fee Schedule and other revisions to Part B for CY 2011, Medicare fee schedule for 2011 H.R.1586, FAA Air Transportation Modernization and Safety Improvement Act, Preventing reduction in Medicaid's payments to states No Bill Number, Geographic payment variation under Medicare, Input to IOM study on value modifier No Bill Number, Graduate Medical Education regulations, GME cost provisions that were in the physician payment rule, workforce development and GME modernization No Bill Number, Discussions with HRSA on Title VII health professions grant programs No Bill Number, Workforce and NIH funding No Bill Number, Accountable Care Organizations regulations, Proposing ways to make primary care practices central to ACOs No Bill Number, Communicating with CMS on Medicare Issues No Bill Number, CMS Prep Call, For meeting with the Administrator, actually meeting with the Administrator, Dr. Don Berwick

Client expense: $2,774,319 · Firm income: Not reported

Government targets: Administration for Children & Families (ACF), Centers For Medicare and Medicaid Services (CMS), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), Office of Personnel Management (OPM), SENATE, Treasury, Dept of, White House Office

Medicare Reimbursement; Sustainable Growth Rate/Physician Fee Schedule Fix; Temporary Increase and Reform of the Federal Medical Assistance Percentage (FMAP); Medicare Advantage Reimbursement; Indirect Medical Education Issues; Hospital Charity Care Issues; Medicare Health Technology; Adoption Incentives; Health Information Technology; H.R. 3961, Medicare Physician Payment Reform Act; H.R. 4872, the Health Care and Education Reconciliation Act of 2010; the Patient Protection and Affordable Care Act (P.L. 111-148); issues related to accountable care organizations; issues related to the Center for Medicare Innovation; FY 2011 Inpatient Prospective Payment System.

Client expense: $90,000 · Firm income: Not reported

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

H.R. 2697 - Optometric Equity in Medicaid Act of 2009, Federal mandates for Medicaid of optometric medical & surgical coverage, all sections SGR - H.R. 3961, Medicare Physician Payment Reform Act, all sections H.R. 3590 Patient Protection and Affordable Care Act H.R. 3962, Affordable Health Care for America Act H.R. 4371, to amend Title XVIII of the Social Security Act, all sections H. Res. 1226 /S. Res. 557, Resolution recognizing 25th Anniversary of Eye Care America Program H.R. 577/S.259, Vision Care for Kids Act of 2009, provide vision care to children, and for other purposes, all sections H.R. 3590, Patient Protection and Affordable Care Act Vision and Eye Health Promotion Act (draft) H.R. 5295, Truth in Advertising Act H.R. 3763 /S.3416, Red Flag Guidelines Legislation H.R. 3652/S.3737, Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

HR 27 Medicare Fraud Prevention and Enforcement Act of 2009, a bill to amend title XVIII of the Social Security Act to establish additional provisions to combat waste, fraud, and abuse within the Medicare Program, and for other purposes; HR 43 and S 46, Medicare Access to Rehabilitation Services Act of 2009, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps; S 54 Registered Nurse Safe Staffing Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing minimum nurse staffing ratios at certain Medicare providers, and for other purposes; HR 319 Legal Immigrant Children's Health Improvement Act of 2009, a bill to amend titles XIX and XXI of the Social Security Act to permit States the option of coverage of legal immigrants under the Medicaid Program and the State children's health insurance program (SCHIP); S 214 Children's Health Equity Technical Amendments Act of 2009, a bill to amend title XXI of the Social Security Act to permit qualifying States to use their allotments under the SCHIP for any fiscal year for certain Medicaid expenditures; HR 362 and S 318 Medicare Rural Health Access Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas; HR 465 a bill to amend titles XIX and XXI of the Social Security Act to permit States to ensure coverage without a 5-year delay of certain children and pregnant women under the Medicaid program and SCHIP; HR 487, a bill to waive the 35-mile requirement for designation of a critical access hospital under the Medicare program; HR 592 and S 264 E-Centives Act of 2009, a bill to amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid Program and the Children's Health Insurance Program, and for other purposes; HR 619 a bill to amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases; S 295 Medicare Quality and Payment Reform Act of 2009, to amend title XVIII of the Social Security Act to improve the quality and efficiency of the Medicare program through measurement of readmission rates and resource use and to develop a pilot program to provide episodic payments to organized groups of multispecialty and multilevel providers of services and suppliers for hospitalization episodes associated with select, high cost diagnoses; HR 668 and S 307 Critical Access Hospital Flexibility Act of 2009, a bill 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 and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans; HR 902 and S. 382 MediFair Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the provision of items and services provided to Medicare beneficiaries residing in States with more cost-effective health care delivery systems; S 434 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid program, and for other purposes; S 438 Improved Medical Decision Incentive Act of 2009, a bill to provide for the voluntary development by States of qualifying best practices for health care and to encourage such voluntary development by amending titles XVIII and XIX of the Social Security Act to provide differential rates of payment favoring treatment provided consistent with qualifying best practices under the Medicare and Medicaid programs, and for other purposes; HR 1117 Medically Fragile Children's Act of 2009, a bill to amend title XIX of the Social Security Act to establish a State plan option under Medicaid to provide an all-inclusive program of care for children who are medically fragile or have one or more chronic conditions that impede their ability to function; HR 1188 and S 468 Access to Emergency Medical Services Act of 2009, a bill to amend title XVIII of the Social Security Act to improve access to emergency medical services and the quality and efficiency of care furnished in emergency departments of hospitals and critical access hospitals by establishing a bipartisan commission to examine factors that affect the effective delivery of such services, by providing for additional payments for certain physician services furnished in such emergency departments, and by establishing a CMS Working Group, and for other purposes; S 712 Rural Medicare Equity Act of 2009, a bill to amend title XVIII of the Social Security Act to improve the Medicare program for beneficiaries residing in rural areas; HR 1776 Quality FIRST (From Incentives, Reporting, Standards, and Technology) Act of 2009, a bill to amend title XVIII of the Social Security Act to expand the development of quality measures for inpatient hospital services, to implement a performance-based payment methodology for the provision of such services under the Medicare Program; Letter to CMS asking to eliminate the state-specific budget neutrality policy for the rural and imputed rural floor indices in the upcoming FY2010 Inpatient Prospective Payment System Rule (IPPS); Working on legislation to amend the Medicare Recovery Audit Contractor Program; S 852 a bill to apply an alternative payment amount under the Medicare program for certain graduate medical education programs established to train residents displaced by natural disasters; HR 2068 Medicare Telehealth Enhancement Act of 2009, a bill to improve the provision of telehealth services under the Medicare Program; HR 2094 Physician Training Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to increase the per resident payment floor for direct graduate medical education payments under the Medicare Program; HR 2124 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and(d) of section 114 of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2204 Medicare Access to Rural Anesthesiology Act of 2009, a bill to amend title XVIII of the Social Security Act to provide payment under part A of the Medicare Program on a reasonable cost basis for anesthesia services furnished by an anesthesiologist in certain rural hospitals in the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals; S 935 Medicare Long-Term Care Hospital Improvement Act of 2009, a bill to extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) to provide for regulatory stability during the development of facility and patient criteria for long-term care hospitals under the Medicare program; HR 2443 Medicare Ambulance Access Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to ambulance services under the Medicare Program; S 1079 Medicare Cost Contract Extension and Refinement Act of 2009, a bill to amend title XVIII of the Social Security Act to extend reasonable cost contracts under the Medicare program; HR 2525 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; HR 2534 Physician Pathology Services Continuity Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the treatment of certain physician pathology services under the Medicare Program; S 1108 Safeguarding Our Hospitals' Futures Act of 2009, a bill to require application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index floor for each all-urban and rural State; S 1110 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1114 Medical Homes Act of 2009, a bill to establish a demonstration project to provide for patient-centered medical homes to improve the effectiveness and efficiency in providing medical assistance under the Medicaid program and child health assistance under the State Children's Health Insurance Program; Letters and further discussions to CMS, Physician Supervision for Outpatient Service, resend policy changes requiring direct physician supervision for all PSO therapeutic Outpatient Service provided in and on hospital campus under Medicare, and withdraw change to minimize legal risk for years 2001-2009; HR 2688 Empowered at Home Act of 2009, a bill to amend title XIX of the Social Security Act to improve the State plan amendment option for providing home and community-based services under the Medicaid Program; HR 2692 and S 1171CAH Designation Waiver Authority Act of 2009, a bill to amend title XVIII of the Social Security Act to restore State authority to waive the 35-mile rule for designating critical access hospitals under the Medicare Program; HR 2718 Medicare Payment Advisory Commission (MedPAC) Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the Medicare Payment Advisory Commission, making the Commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; S 1185 Medicare Financial Stability for Beneficiaries Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs; S 1181 Healthy Living and Health Aging Demonstration Project Act of 2009, a bill to provide for a demonstration project to examine whether community-level public health interventions can result in lower rates of chronic disease for individuals entering the Medicare program; HR 2753 a bill to delay the implementation of new Medicare hospital geographic wage reclassification criteria until the Secretary of Health and Human Services issues a proposal to revise the hospital wage index classification system that addresses certain considerations; HR 2758 Medicare Specialty Care Improvement and Protection Act of 2009, a bill to amend part C of title XVIII of the Social Security Act with respect to Medicare special needs plans and the alignment of Medicare and Medicaid for dually eligible individuals; HR 2773 Medicare Transitional Care Act of 2009, a bill to amend title XVIII of the Social Security Act to cover transitional care services to improve the quality and cost effectiveness of care under the Medicare Program; S 1218 Urban Medicare-Dependent Hospitals Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to preserve access to urban Medicare-dependent hospitals; HR 2784 Partnership to Improve Seniors Access to Medicare Act, a bill to establish a loan repayment program for qualifying physicians and nurse practitioners participating in the Medicare Program; HR 2805 Ensuring Continuous Medicaid Coverage for Children Act of 2009, a bill to amend title XIX of the Social Security Act to require 12-month continuous coverage for children under Medicaid; HR 2844 Medicare Payment Improvement Act of 2009, a bill to amend title XVIII of the Social Security Act to create a value indexing mechanism for the physician work component of the Medicare physician fee schedule; HR 2859 Strengthening Medicaid for America's Children Act of 2009, a bill to amend title XIX of the Social Security Act to provide for application of an enhanced Federal matching rate for children under the Medicaid Program if certain conditions are met; S 1262 Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009, a bill to amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes; S 1263 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; HR 2919 Medicare Efficiency Incentive Act of 2009, a bill to amend part B of title XVIII of the Social Security Act to provide Medicare physician incentive payments for efficient areas; HR 2921a bill to amend title XVIII of the Social Security Act to provide for an annual review by the MedPAC on geographic access to services; S 1279 TARP Recipient Ownership Trust Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; HR 2959 Accountable Care Promotion Act of 2009, a bill to amend title XVIII of the Social Security Act to establish an accountable care organization pilot program to reduce the growth of expenditures and improve health outcomes under the Medicare Program; S 1300 Community and Rural Medical Residency Preservation Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify intent regarding the counting of residents in a nonhospital setting under the Medicare program; S 1380 MedPAC Reform Act of 2009, a bill to amend title XVIII of the Social Security Act to create a sensible infrastructure for delivery system reform by renaming the MedPAC, making the commission an executive branch agency, and providing the Commission new resources and authority to implement Medicare payment policy; H.R. 3138 Physician Payments Sunshine Act of 2009, a bill to amend title XI of the Social Security Act to provide for transparency in the relationship between physicians and manufacturers of drugs, devices, biologicals, or medical supplies for which payment is made under Medicare, Medicaid, or SCHIP; HR 3141 Strengthening the Health Care Safety Net Act of 2009, a bill to amend title XIX of the Social Security Act to provide for a DSH redistribution pool from unexpended Medicaid DSH allotments in order to increase Medicaid DSH allotments for low DSH States and to provide grants for health access networks serving the uninsured; H.R. 3152 Helping Seniors Choose their Medicare Drug Plan Act, a bill to amend titles XVIII of the Social Security Act to ensure that low-income beneficiaries have improved access to prescription drugs under the Medicare and Medicaid programs; S. 1423 Medicaid Birth Center Reimbursement Act, a bill to amend title XIX of the Social Security Act to require coverage under the Medicaid Program for freestanding birth center services; S. 1427 Department of Veterans Affairs Hospital Quality Report Card Act of 2009, a bill to amend title 38, United States Code, to establish a Hospital Quality Report Card Initiative to report on health care quality in Department of Veterans Affairs Medical Centers, and for other purposes; H.R. 3172 Senior Navigation and Planning Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for advanced illness care management services for Medicare beneficiaries, and for other purposes; H.R. 3184 Medicare Independent Living Act of 2009, a bill to amend title XVIII of the Social Security Act to eliminate the in the home restriction for Medicare coverage of mobility devices for individuals with expected long-term needs; H.R. 3256 Rural Community Hospital Demonstration Extension Act of 2009, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the Rural Community Hospital Demonstration Program; H.R. 3356 Medicare Beneficiary Freedom to Choose Act of 2009, a bill to amend title XVIII of the Social Security Act to clarify the use of private contracts by Medicare beneficiaries for professional services and to allow individuals to choose to opt out of the Medicare part A benefits; H.R. 3361 Medicare Patient Safeguards Act of 2009, a bill to provide a process for public comment and Medicare Evidence Development & Coverage Advisory Committee review of certain Medicare national coverage determinations, and for other purposes; HR 3369 and S.1521 Improve Act of 2009, a bill to amend titles XVIII and XIX of the Social Security Act to require provider payments under Medicare and Medicaid to be made through direct deposit or electronic funds transfer (EFT) at insured depository institutions; S.1522 Outpatient Mental Health Modernization Act of 2009, a bill to amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program; H.R. 3374 Medicare and Medicaid Access Project through Information Technology (MAP IT) Act, a bill to provide for a demonstration project relating to the impact of health information technology on chronic disease management under the Medicare and Medicaid programs; H.R. 3422 Medicare Support for Rural Hospitals Act, a bill to amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals; H.R. 3430 DSH Collaborative Care Network Pilot Program Act of 2009, a bill to establish a Medicare DSH pilot program under which participants shall establish collaborative care networks to reduce the use of emergency departments, inpatient and other expensive resources of hospitals and other providers and provide more comprehensive and coordinated care to low-income individuals, including those without health insurance coverage, and to establish a Collaborative Care Network Center; Neal Letter to Pelosi, Opposition to the Independent Medicare Advisory Council (IMAC) and MedPAC Reform Act (HR 2718, S1110, S 1380); HR 3556 NO TITLE, a bill to require the Secretary of Health and Human Services to establish a self-referral disclosure protocol under the Medicare Program to enable health care providers of services and suppliers to disclose violations of section 1877 of the Social Security Act; S 1669 Equal Access to Medicare Options Act of 2009, a bill to provide all Medicare beneficiaries with the right to guaranteed issue of a Medicare supplemental policy; HR 3631 Medicare Premium Fairness Act, a bill to amend title XVIII to provide for the application of a consistent Medicare part B premium for all Medicare beneficiaries in a budget neutral manner for 2010; HR 3653 Medicare Card Security Act of 2009, a bill to amend title II of the Social Security Act to prohibit the display of Social Security account numbers on Medicare cards; HR 3663 NO TITLE, a bill to amend title XVIII of the Social Security Act to delay the date on which the accreditation requirement under the Medicare Program applies to suppliers of durable medical equipment that are pharmacies; HR 3665 Ryan White Grantee Medicaid Payment Equity Act of 2009, a bill to amend title XIX of the Social Security Act to provide for payment for Medicaid services furnished by Ryan White part C grantees under a cost-based prospective payment system; HR 3675 National Quality Cancer Care Demonstration Project Act of 2009, a bill to improve the quality and cost effectiveness of cancer care to Medicare beneficiaries by establishing a national demonstration project; HR 2962 Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, a bill to amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral; Meeting with CMS re implementation of new requirements for insurance providers to report payment responsibility for Medicare Secondary Payer program; HR 3693 Ensuring the Future Physician Workforce Act of 2009, a bill to amend title XVIII of the Social Security Act to modify Medicare physician reimbursement policies to ensure a future physician workforce; HR 3961, HR 4154, S 1600 and Reid amendment 3305 Medicare Physician Payment Reform Act of 2009 and Statutory Pay-As-You-Go Act of 2009, a bill to amend title XVIII of the Social Security Act to reform the Medicare SGR payment system for physicians and to reinstitute and update the Pay-As-You-Go requirement of budget neutrality on new tax and mandatory spending legislation, enforced by the threat of annual, automatic sequestration; HR 4250 Medicaid DSH Integrity Act, a bill to direct the Secretary of Health and Human Services to revise regulations implementing the statutory reporting and auditing requirements for the Medicaid disproportionate share hospital ("DSH") payment program to be consistent with the scope of the statutory provisions and avoid substantive changes to preexisting DSH policy; S 1776 Medicare Physician Fairness Act of 2009, a bill to amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes; discussion with the HHS Office of the National Coordinator for Health Information Technology of hospital concerns around development of requirements for meaningful use of Electronic Health Records (EHR) to qualify for Medicare and Medicaid incentive payments for EHR development; S 3000 a bill to extend the increase in the FMAP provided in the American Recovery and Reinvestment Act of 2009 for an additional 6 months; HR 4213 American Workers, State, and Business Relief Act of 2010 a bill that includes an extension of the Recovery Acts increased Federal match for state Medicaid programs. The passed bill extends the increased FMAP through June 30, 2011, which is estimated to provide states with an additional $25.5 billion in FMAP; Letter to Pelosi and Reid expressing opposition to establishment of an Independent Payment Advisory Board (IPAB); Medicaid FMAP ARRA Extension Letter to Senator Reid to include an extension of federal Medicaid assistance to states in legislative proposals to increase employment and rebuild the nations economy; Space, Burgess, Stearns and Engel House Health IT letter and Klobuchar and Hatch Senate Health IT letter to CMS urging a modification of CMS proposed definition of and requirements for hospitals to become qualified as meaningful users of certified electronic health record (EHR) technology; S 3028 Medicare Mental Health Inpatient Equity Act, to amend title XVIII of the Social Security Act to eliminate the 190-day lifetime limit on inpatient psychiatric hospital services under the Medicare program; HR 4872 The Health Care and Education Affordability Reconciliation Act of 2010, to provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010; Meetings with CMS to urge a different interpretation of the Medicare conditions of participation interpretive guidelines, as currently interpreted guidelines would require accreditation of each hospital as a standalone entity and require them to each have a separate governing body, medical staff, etc. in order to be accredited by the joint commission; Crowley- Sessions Letter to CMS urging reevaluation of the IPPS regulation that would apply a 2.9 percent cut to hospital payments in FY 2011; Letter to CMS re development of the Self-referral disclosure protocol that is authorized by the PPACA; HR 5712 Veterans, Seniors, and Childrens Health Technical Corrections Act of 2010 to provide for certain clarifications and extensions under Medicare, Medicaid, and the Children's Health Insurance Program; HR 6005 Ensuring Equality for Early EHR Adoption Act of 2010, to amend titles XVIII and XIX of the Social Security Act to provide for the temporary treatment of certain electronic health records as certified EHR technology for purposes of health information technology payment incentives under the Medicare and Medicaid Programs. Sen. Stabenow and Sen. Murkoswki, Rep. Crowley and Rep. Sessions letter to CMS asking to reevaluate the proposed IPPS regulations that will hit hospital payments in FY 2011; Pomeroy, Moran letter to CMS, regarding concersn of the proposed Medicare OPPS regulation for FY 2011 does not show continued access to full range of outpatient therapeutic services for small, rural & CAH hospitals.

Client expense: $4,270,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, White House Office

H.R. 4851, The Continuing Extension Act of 2010 - Support delay of 21% cut in Medicare Reimbursement thru 5/31 (Public Law 111-157). H.R. 4213, Short term Extension - support delay of Medicare Physician Pay cut until September 30th. Regulations stemming from the H.R. 3590, Patient Protection and Affordable Care Act - Health Care Reform and impact on physicians payment and physican workforce issues and regulations implementing law. Regulations stemming from inactment of H.R. 4872, the Reconciliation Act of 2010. Regulations implementing Health Information Technology, meaningful use, electronic health records, medicare enrollment (PECOS), ICD-10. H.R. 3961 Medicare Physician Payment Reform Act of 2009, SGR Fix and block cut in Medicare Physician Fee and regulations affecting physician pay.

Client expense: Not reported · Firm income: $20,000

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

Medicare Reimbursement; Sustainable Growth Rate/Physician Fee Schedule Fix; Temporary Increase and Reform of the Federal Medical Assistance Percentage (FMAP); Medicare Advantage Reimbursement; Indirect Medical Education Issues; Hospital Charity Care Issues; Medicare Health Technology Adoption Incentives; Health Information Technology; H.R. 3961, Medicare Physician Payment Reform Act; H.R. 4872, the Health Care and Education Reconciliation Act of 2010; the Patient Protection & Affordable Care Act (P.L. 111-148); issues related to accountable care organizations; FY 2011 Inpatient Prospective Payment System.

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

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

Medicare hospital reimbursement issues and Medicare graduate medical education reimbursement issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L. 111-5) provisions related to moratorium on Medicare capital IME regulation (CMS 1390-F, CMS-1406-P), Medicare HIT investments and requirements; 42 CFR 413.79; President Obama proposals on Medicare bundled payments, reimbursement for readmissions, value-based purchasing (Budget Resolutions, H Con Res 312, S Con Res 70); Resident Physician Shortage Reduction Act (H.R. 2251/S. 973); Medicare provisions in various health care reform proposals (including disproportionate share hospital, GME, bundling, readmissions, value-based purchasing, wage index, market basket, gainsharing, and other provisions in the Affordable Health Care for America Act (H.R.3962); Patient Protection and Affordable Care Act (H.R.3590, P.L. 111-148)); and Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), P.L. 111-152); Medicare Commission legislation (S.1110, S. 1380, H.R.2718), provisions that would empower a Commission to implement Medicare policy changes; geographic variation legislation (H.R. 2844, H.R. 2919, H.R. 2921, H.R. 2201, S.Amdt. 887) affecting hospitals and/or physician payment policy; value-based purchasing legislation (H.R. 1776); other workforce legislation (H.R. 1946, S.1569)); Puerto Rico Medicare Parity (H.R. 2680, H.R. 1501, H.R.1502); Medicare physician payment adjustment (HR. 3961, S.1776, H.R.3326, H.R. 3590, H.R. 4851, S. 3153, H.R. 4213); Section 508 wage index extension and gainsharing extension (H.R. 4213); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); Medicare 72-hour payment window limitation (H.R.4213); HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S. 3708); and the "coding offset" in the proposed and final Medicare inpatient prospective payment system rule for 2011 (CMS-1498). Medicaid issues (American Recovery and Reinvestment Act of 2009, H.R. 1 (P.L.111-5) and ARRA FMAP Extension (H.R. 4263, H.R. 2847, H.R.4213) provisions related to the Federal Medical Assistance Percentage, provisions related to disproportionate share hospitals, moratoria on Medicaid regulations (CMS-2258-FC,CMS-2279-P, CMS-2213-P, CMS-2275-F, CMS-2287-P), and HIT investments; Medicaid provisions in various health care reform proposals (including the American Health Care Choices Act (Senate HELP Committee bill (S.1679), Affordable Healthcare for America Act (H.R. 3962), Patient Protection and Affordable Care Act (H.R. 3590, P.L. 111-148), and the Health and Education Affordability Reconciliation Act of 2010 (H.R. 4872, P.L. 111-152)), including disproportionate share hospital and FMAP provisions; New York State 1115 Medicaid waiver Partnership Plan extension (11-W-00114/2) provisions related to hospitals; the Medicaid Emergency Psychiatric Care Demonstration Project Act of 2009 (S.1130/H.R.1415); Medicaid incentives for HIV screening (H.R. 3091/S.1446)); HIT incentive payment legislation affecting hospitals and physicians in response to proposed rule CMS-0033-P (H.R. 4851, S. 3153, H.R. 4213); and HIT incentive payments and meaningful use requirements in final rule CMS-0033-F (H.R. 6072, S.3708).

Client expense: $300,000 · Firm income: Not reported

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. Health Coverage: Guarantee all Americans access to health coverage; create tax credits to subsidize coverage for low income persons to buy into the Federal Employees Health Benefits Plan (FEHBP); create new options for small businesses to buy into group coverage based on the FEHBP; expand Medicaid and CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP program with additional funding to assure adequate coverage of all eligible children; target increases in Medicare payments for primary care physicians; target incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home; provide subsidies for newly unemployed workers to obtain COBRA coverage; provide temporary Medicaid coverage to laid-off workers; increase funding for community health centers; provide substantial funds for the Prevention and Wellness Fund to fight preventable chronic diseases; support healthcare research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and CHIP; support existing work being done by public and private sector partnerships on HIT policy, standards and certification; H.R. 1, the American Recovery and Reinvestment Act. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for Medicare physician payments at least through 2011. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646). Healthcare in the FY2010 and FY2011 Budget: Account for the costs of preventing Medicare physician pay cuts under the Sustainable Growth Rate formula; address the negative impact of Medicare payment cuts on small physician practices; support the concept of dedicating funding for health care reform; support funding for physicians to acquire health information technology (HIT) to be used in a meaningful way; note concerns about penalties that would reduce baseline payments to physicians not using certified HIT systems beginning in 2015; support a policy reserve fund for physician payment reform, as reported out of the House Committee on the Budget, including the language to ensure primary care receives appropriate compensation. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268, provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $277,506 · Firm income: Not reported

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

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act; S. 1004 and H.R. 2307, the Reaching Elders with Assessment and Chronic Care Management and Coordination Act, or the RE-Aligning Care Act, would create a Medicare benefit for a comprehensive geriatric assessment for beneficiaries with chronic diseases or dementia. The legislation would also provide a separate Medicare monthly payment to physicians who provide ongoing care coordination services for such patients. Health Coverage: Guarantee all Americans access to health coverage; create tax credits to subsidize coverage for low income persons to buy into the Federal Employees Health Benefits Plan (FEHBP); create new options for small businesses to buy into group coverage based on the FEHBP; expand Medicaid and CHIP; support state experimentation. Economic Stimulus Legislation: Increase the federal matching rate under the Medicaid program, re-authorize the CHIP program with additional funding to assure adequate coverage of all eligible children; target increases in Medicare payments for primary care physicians; target incentives directed toward primary care physicians in smaller practices to acquire health information technology (HIT) applications to support care coordination through the medical home; provide subsidies for newly unemployed workers to obtain COBRA coverage; provide temporary Medicaid coverage to laid-off workers; increase funding for community health centers; provide substantial funds for the Prevention and Wellness Fund to fight preventable chronic diseases; support healthcare research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and CHIP; support existing work being done by public and private sector partnerships on HIT policy, standards and certification; H.R. 1, the American Recovery and Reinvestment Act. Medicare Physician Payment Reform: Increase Medicare Fee Schedule Payments to make primary care competitive in the market with other physician career and specialty choices; create a fast track authority to develop and implement new physician payment models that better align payment with effective, efficient, patient-centered care such as the Patient Centered Medical Home; provide separate Medicare payment for specific care coordination services provided principally by primary care physicians; revise Medicare budget neutrality rules to recognize the value of primary care in reducing Medicare baseline spending; increase the accuracy of physician work relative value units under the Medicare physician fee schedule; improve the accuracy of practice expense RVUs under the Medicare Fee Schedule; increase Medicare bonus payments for primary care services provided in designated shortage areas; provide stable, positive, predictable updates under Medicares reimbursement formula; and replacing the Sustainable Growth Rate (SGR) formula with a long term solution that provides for stable, predictable updates for physicians (H.R. 3961). H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, which contained a temporary extension of current SGR payments to physicians; H.R. 3962, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which sets 2.2% as the update to the single conversion factor in the formula for determining physician payment rates for June 1, 2010, through November 30, 2010; Urged action on legislation to provide stability and predictability for Medicare physician payments at least through 2011. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate GME caps for residency programs in primary care; restore the 20/220 loan deferment pathway (S.646). Healthcare in the FY2010 and FY2011 Budget: Account for the costs of preventing Medicare physician pay cuts under the Sustainable Growth Rate formula; address the negative impact of Medicare payment cuts on small physician practices; support the concept of dedicating funding for health care reform; support funding for physicians to acquire health information technology (HIT) to be used in a meaningful way; note concerns about penalties that would reduce baseline payments to physicians not using certified HIT systems beginning in 2015; support a policy reserve fund for physician payment reform, as reported out of the House Committee on the Budget, including the language to ensure primary care receives appropriate compensation. Appropriations FY2011: Advocated for strong investment in Titles VII and VIII programs in FY 2011 Labor, Health & Human Services & Educations appropriations bills; these programs provide direct financial support for health care workforce development and education. Advanced Care Planning: The Personalize Your Care Act of 2010; provides coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans. It would also provide states and communities with grants to create or expand programs that assist with advanced care planning. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Preserving the Safety Net Function of Federally-funded Health Care Programs, such as CHIP: H.R. 5268, provide for a temporary increase of the Federal medical assistance percentage under the Medicaid Program; include expansion of the medical home as well as transformation grants for the medical home in CHIP re-authorizing legislation. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test new Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; implementing a new 2-prong demonstration project consisting of an independent practice-based medical home model and a community-based medical home model, a State Medicaid health (medical) home option, an Independence at Home demonstration project that contains many medical home features, the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Improve Medicare fee for service system payments to make primary care competitive with other specialties. Direct the Secretary of HHS to conduct a market analysis to determine how much payments for primary care should be increased to make primary care physicians competitive with other specialties within five years, starting with a major increase in 2010 as the first step toward market competitiveness; Replace the Sustainable Growth Rate formula with a system that provides fair, predictable, and stable updates for physician services, and fully account for such changes in the Medicare baseline spending assumptions; enacting a 10% bonus payment under Medicare for primary care services. Establish a national workforce policy to ensure sufficient numbers of primary care and other physicians. Establish a national workforce commission to recommend national goals relating to the numbers and distribution of physicians and other health care professionals, including increasing the supply of primary care physicians; Increase the number of Medicare-funded graduate medical education positions available each year in adult primary care specialties; Provide new loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities, or in critical shortage areas of the country; Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reform the medical liability system and the enormous costs associated with frivolous lawsuits and defensive medicine; Impose caps on non-economic damages; and test and fund new models--like health courts, which would have cases heard by an expert panel rather than by a lay jury. Additional issues under H.R. 3590 and H.R. 3962. Requiring a study by the Institute of Medicine of geographic variations in quality and cost of care and methodologies to reduce such variation; Establishing Innovation Center to fast-track testing of new payment models; Improving the Physician Quality Reporting Initiative (PQRI) and ensuring that no punitive payment penalties are imposed under PQRI; Increasing Medicaid payment rates to physicians to those of Medicare; Funding for a transparent process to conduct Comparative Effectiveness Research (CER); Administrative simplification; Appointments to the new Workforce Commission, and Patient-Centered Outcomes Research Institute (PCORI), as created under the Patient Protection and Affordable Care Act.

Client expense: $136,378 · Firm income: Not reported

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