To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services.

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues-HHPPS Proposed Rule 2011, SNF Updates 2011 Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency Legislative Recommendations for Medicaid & CHIP- RFI June 2010 MedPAC Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009 HIT Rules- Meaningful Use Health Exchanges Proposed Rule Multiple Procedure Payment Reduction In Office Ancillary Services/Self Referral Annual Wellness Visit Rule Extension of Federal Medical Assistance Percentages H.R. 4994- the Medicare and Medicaid Extenders Act H.R. 5712- the Physician Payment and Therapy Relief Act of 2010 Comments on Physician Compare Federal External Review Process Comments

Client expense: $240,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 2204, Medicare Access to Rural Anesthesiology Act: Rural Pass Through; S.1157, Craig Thomas Rural Hospital and Provider Equity Act of 2009; Johnson Amendment, An amendment to H.R. 3200 to set Medicare payment rates for anesthesia services at a rate not less than the average paid by exchange participant health benefit plans. H.R. 4371, To amend the Social Security Act to continue using 2009 relative value units for certain cardiology services. Part B Medicare Physician's Fee Schedule: Implementation of Medicare Anesthesiology Teaching Funding Restoration Act H.R. 4851, The Continuing Extension Act of 2010 H.R. 4213, Tax Extenders Act of 2009 H.R. 4691, The Temporary Extension Act of 2010 H.J. Res. 45 Statutory Pay-As-You-Go Act of 2010 H.R. 4872, The Health Care and Education Affordability and Reconciliation Act of 2010 2010 Medicare Physician Fee Schedule proposed and final rules Medicare Reform, Payment Issues: Physician Quality Reporting Initiative, Medicare Sustainable Growth Rate Physician Payment Update Scope of Practice Bundled payments CMS Interpretive Guidelines CMS IPPS Medicare Payment CMS Physician Resource Use Reports CMS ICD-10 CMS Hospital Outpatient Payment Proposed Rule CMS Hospital Acquired Conditions CMS Value-Based purchasing CMS Recovery Audit Contractors Program CMS Practicing Physicians' Advisory Council Nominations Medicaid Expansion: Provider payment levels Medicare Expansion, Ages 55-64 Independent Payment Advisory Board (IPAB) Balance billing MedPAC nominations CMS Handoffs Accountable Care Organizations Misvalued codes Historical Medicare payment undervaluation for anesthesiology services (33% problem) Medical loss ratios Anesthesia Conversion Factor Public Plan - Negotiated Provider Payment Rates

Client expense: $210,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE

Medicare physician payment; Health Care Quality; Medical Imaging; Medicare reimbursement for cardiology. H.R. 4371, A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for cardiology services. Medicare Physician Payment Issues. (See Continuation Page) H.R. 6459, To amend Section 1848 of the Social Security act to provide for a four year transition in reductions in relative value units for certain newly handled services to allow physician practice time to adjust to new payment rates. H.R. 4994, Medicare and Medicaid Extenders Act of 2010 (Became PL 111-309 on 12/15/10)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment (SGR fix), H.R. 4371 (to mitigate cuts to cardiology payment), imaging payment policy (self referral, prior authorization, payment cuts for advanced imaging services, effects of payment policy on health care disparities)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Medicare Payment Advisory Commission (MedPAC), SENATE

Medicare physician payment (SGR patch), H.R. 4371 (correct cardiology payment cuts), imaging paymnet policy, imaging demo grant support letter

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Medicare Payment Advisory Commission (MedPAC), 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)

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy. HR 3184/S 1186 - Medicare Independent Living Act: Advocate for passage No bill #: Health Care Reform; Educate about recommendations and position of the American Occupational Therapy Association regarding occupational therapy. HR 3200 - America's Affordable Health Choices Act of 2009: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy. HR 2891 - Access to Frontline Health Care Act of 2009: Support passage. HR 3590 (PL 111-148) - Patient Protection and Affordable Care Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. Advocated for passage of short and long-term solutions to the Medicare Physician Fee Schedule payment cuts spurred by the Sustainable Growth Rate (SGR) formula. No Bill #: Advocate for extension of Medicare Therapy Caps Exceptions process. HR 3790 - To amend title XVIII of the Social Security Act to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner: educated and advocated on impact on occupational therapy services. HR 5040 - Health Information Technology Extension for Behavioral Health Services Act of 2010: advocated for passage and educated about occupational therapy services. HR 1708 - Ending the Medicare Disability Waiting Period Act of 2009: Advocated for passage. HR 4993 - Home Health Care Planning Improvement Act of 2010: Advocated for passage and educated about occupational therapy services. S 3216 - Medicare Rural Health Care Equity Act of 2010: Advocated for passage. HR 4371 - A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services: Advocated regarding impact to occupational therapy services. No bill: Advocate to Congress and Centers for Medicare/Medicaid Services (CMS) to oppose proposed Medicare Physician Payment Reductions, cuts to therapy reimbursement in the proposed 2011 Medicare Physician Fee Schedule rule. CMS staff: Marilyn Tavenner, Principal Deputy Administrator and Johnathan Bluhm, Director of Center for Medicare Management HR 1586 - Education and Medicaid Funding for States: Supported passage.

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, White House Office

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 3962, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, all sections relating to vision. HR 4213, American Jobs and Closing Tax Loopholes 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 5424, Reform Americans Can Afford Act of 2010, all sections relating to vision. HR 6290, To amend title XIX of the Social Security Act to require Medicaid coverage of optometrists, all sections relating to vision.

Client expense: $254,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency June 2010 Medpac Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Issues related to hospital readmissions/bundling and home infusion therapy coverage, (the Medicare Home Infusion Therapy Coverage Act of 2009 (HR 574/S 254)) The Comprehensive Immunosuppressive Drug Coverage for Transplant Patients Act (HR 1458/S 565) Issues related to Medicare physician payment system (to amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services, (HR 4371)), and CPT codes for myocardial perfusion imaging. The Health Care and Education Reconciliation Act of 2010 (HR 4872), the Patient Protection and Affordable Care (HR 3590), and the Affordable Health Care for America Act (HR 3962). Issues related to oncology coverage and medicare clinical trials (the Comprehensive Cancer Care Improvement Act of 2009 (HR 1844)).

Client expense: $310,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to hospital readmissions/bundling and home infusion therapy coverage, (the Medicare Home Infusion Therapy CoverageAct of 2009 (HR 574/S 254)) The Comprehensive Immunosuppressive Drug Coverage for Transplant Patients Act (HR 1458/S 565) Issues related to Medicare physician payment system (to amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services, (HR 4371)), and CPT codes for myocardial perfusion imaging. The Health Care and Education Reconciliation Act of 2010 (HR 4872), the Patient Protection and Affordable Care (HR 3590), and the Affordable Health Care for America Act (HR 3962). Issues related to oncology coverage and medicare clinical trials, the 21st Century Cancer ALERT ("Access to Life-Saving Early detection, Research and Treatment" Act (HR1844)).

Client expense: $560,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues-HHPPS Proposed Rule 2011, SNF Updates 2011 Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency Legislative Recommendations for Medicaid & CHIP- RFI June 2010 Medpac Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009 HIT Rules- Meaningful Use Health Exchanges Proposed Rule Multiple Procedure Payment Reduction In Office Ancillary Services Annual Wellness Visit Rule Extension of Federal Medical Assistance Percentages

Client expense: $310,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Medicare physician payment; Health Care Quality; Medical Imaging; Medicare reimbursement for cardiology. H.R. 4371, A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for cardiology services. Medicare Physician Payment Issues: H.R.4213, American Jobs and Closing Tax Loopholes Act of 2010 (Became PL 111-205 on July 22, 2010)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2204, Medicare Access to Rural Anesthesiology Act: Rural Pass Through; S.1157, Craig Thomas Rural Hospital and Provider Equity Act of 2009; S.1776, Medicare Physician Fairness Act of 2009; H.R. 3961, Medicare Physician Payment Reform Act of 2009; Johnson Amendment, An amendment to H.R. 3200 to set Medicare payment rates for anesthesia services at a rate not less than the average paid by exchange participant health benefit plans. H.R. 4371, To amend the Social Security Act to continue using 2009 relative value units for certain cardiology services. Part B Medicare Physician's Fee Schedule: Implementation of Medicare Anesthesiology Teaching Funding Restoration Act H.R. 4851, The Continuing Extension Act of 2010 H.R. 4213, Tax Extenders Act of 2009 H.R. 4691, The Temporary Extension Act of 2010 H.J. Res. 45 Statutory Pay-As-You-Go Act of 2010 H.R. 4872, The Health Care and Education Affordability and Reconciliation Act of 2010 2010 Medicare Physician Fee Schedule proposed and final rules Medicare Reform, Payment Issues: Physician Quality Reporting Initiative, Medicare Sustainable Growth Rate Physician Payment Update Scope of Practice Bundled payments CMS ACE Demonstration CMS Interpretive Guidelines CMS IPPS Medicare Payment CMS Physician Resource Use Reports CMS ICD-10 CMS Medicare Physician Practice Expense Relative Value Units CMS Hospital Outpatient Payment Proposed Rule CMS Hospital Acquired Conditions CMS Value-Based purchasing CMS Recovery Audit Contractors Program CMS Practicing Physicians' Advisory Council Nominations Medicaid Expansion: Provider payment levels Medicare Expansion, Ages 55-64 Independent Payment Advisory Board (IPAB) Balance billing MedPAC nominations CMS Handoffs Anesthesia Information Management System (AIMS) Accountable Care Organizations Misvalued codes Historical Medicare payment undervaluation for anesthesiology services (33% problem) Medical loss ratios Nevada Medicaid anesthesia payment rates Anesthesia Conversion Factor Public Plan - Negotiated Provider Payment Rates

Client expense: $210,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE

Medicare physican payment; Health Care Quality; Medical Imaging; HR 4371, Medicare reimbursement for cardiology services; HR 3962, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010; HR 4213, American Jobs and Closing Tax Loopholes Act of 2010; HR 4851, Continuing Extension Act of 2010

Client expense: $460,000 · Firm income: Not reported

Government targets: 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

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 3590, Patient Protection and Affordable Care Act , 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 4213, American Jobs and Closing Tax Loopholes 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 4851, Continuing Extension Act of 2010, all sections relating to vision. HR 5424, Reform Americans Can Afford Act of 2010, all sections relating to vision.

Client expense: $332,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 186 Glaucoma Screening Act of 2009, all sections relating to vision. HR 228 To direct the Secretary of Veterans Affairs to establish a scholarship program for students seeking a degree or certificate in the areas of visual impairment and orientation and mobility, all sections relating to vision. HR 577 Vision Care for Kids Act of 2009, all sections relating to vision. HR1402,Catalyst to Better Diabetes Care Act of 2009, all sections relating to vision. HR 1884, National Health Service Corps Improvement Act of 2009, all sections relating to vision. H.R.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 3590, Patient Protection and Affordable Care Act, 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 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. H.Res. 1226. Commending EyeCare America for its work over the last 25 years, all sections relating to vision. S. 259, Vision Care for Kids Act of 2009, all sections relating to vision. S.Res.557, A resolution commending EyeCare America for its volunteerism and efforts to preserve eyesight throughout the previous 25 years, all sections relating to vision.

Client expense: $332,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 2697 - Optometric Equity in Medicaid Act of 2009, Federal mandates for Medicaid of optometric medical & surgical coverage, all sections SGR - HR 3961, Medicare Physician Payment Reform Act, all sections HR 3590 Patient Protection and Affordable Care Act HR 3962 Affordable Health Care for America Act HR 4371, to amend Title XVIII of the Social Security Act, all sections H ReS. 1226, Resolution recognizing 25th Anniversary of Eye Care America Program HR 577/S 259 - Vision Care for Kids Act of 2009, provide vision care to children, and for other purposes, all sections HR 3590, Patient Protection and Affordable Care Act

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

H.R. 2204, Medicare Access to Rural Anesthesiology Act: Rural Pass Through; S.1157, Craig Thomas Rural Hospital and Provider Equity Act of 2009; S.1776, Medicare Physician Fairness Act of 2009; H.R. 3961, Medicare Physician Payment Reform Act of 2009; Johnson Amendment, An amendment to H.R. 3200 to set Medicare payment rates for anesthesia services at a rate not less than the average paid by exchange participant health benefit plans. H.R. 4371, To amend the Social Security Act to continue using 2009 relative value units for certain cardiology services. Part B Medicare Physician's Fee Schedule: Implementation of Medicare Anesthesiology Teaching Funding Restoration Act H.R. 4851, The Continuing Extension Act of 2010 H.R. 4213, Tax Extenders Act of 2009 H.R. 4691, The Temporary Extension Act of 2010 H.J. res. 45 Statutory Pay-As-You-Go Act of 2010 H.R. 4872, The Health Care and Education Affordability and Reconciliation Act of 2010 2010 Medicare Physician Fee Schedule proposed and final rules Medicare Reform, Payment Issues: Physician Quality Reporting Initiative, Medicare Sustainable Growth Rate Physician Payment Update Scope of Practice Bundled payments CMS ACE Demonstration CMS Interpretive Guidelines CMS IPPS Medicare Payment CMS Physician Resource Use Reports CMS ICD-10 CMS Medicare Physician Practice Expense Relative Value Units CMS Hospital Outpatient Payment Proposed Rule CMS Hospital Acquired Conditions CMS Value-Based purchasing CMS Recovery Audit Contractors Program CMS Practicing Physicians' Advisory Council Nominations Medicaid Expansion: Provider payment levels Medicare Expansion, Ages 55-64 Independent Medicare Advisory Committee (IMAC) and Independent Medicare Advisory Board (IMAB) Balance billing MedPAC nominations CMS Handoffs Anesthesia Information Management System Accountable Care Organizations Misvalued codes Historical Medicare payment undervaluation for anesthesiology services (33% problem) Medical loss ratios Nevada Medicaid anesthesia payment rates

Client expense: $340,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE

See page three for specific Health issues. H.R. 3590 - Patient Protection and Affordable Care Act H.R. 4872 - Health Care and Education Reconcilation Act of 2010 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4371 - Amend title XVIII/RVU for cardiology H.R. 5295 - Healthcare Truth and Transparency Act of 2010 H.R. 4851 - Continuing Extension Act of 2010 H.R. 4213 - American Jobs and Closing Tax Loopholes Act of 2010 Surgical Workforce Shortage Veterans Ophthalmology/Optometery Issues Oil Spill Health Effects Health Care in Rural Areas Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009 National Healthcare Workforce Commission Patient-Centered Outcomes Research Institute's Board of Governors Ambulatory Surgical Center Reimbursement HIT Meaningful Use Independent Payment Advisory Board/Health Care Reform

Client expense: $7,619 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page three for specific Medicare/Medicaid issues. H.R. 3590 - Patient Protection and Affordable Care Act H.R. 4872 - Health Care and Education Reconcilation Act of 2010 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4371 - Amend title XVIII/RVU for cardiology H.R. 5295 - Healthcare Truth and Transparency Act of 2010 H.R. 4851 - Continuing Extension Act of 2010 H.R. 4213 - American Jobs and Closing Tax Loopholes Act of 2010 Surgical Workforce Shortage Veterans Ophthalmology/Optometery Issues Oil Spill Health Effects Health Care in Rural Areas Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009 National Healthcare Workforce Commission Patient-Centered Outcomes Research Institute's Board of Governors Ambulatory Surgical Center Reimbursement HIT Meaningful Use Independent Payment Advisory Board/Health Care Reform

Client expense: $7,619 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page five for specific Health issues. H.R. 3590 - Patient Protection and Affordable Care Act H.R. 4872 - Health Care and Education Reconcilation Act of 2010 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4371 - Amend title XVIII/RVU for cardiology H.R. 5295 - Healthcare Truth and Transparency Act of 2010 H.R. 4851 - Continuing Extension Act of 2010 H.R. 4213 - American Jobs and Closing Tax Loopholes Act of 2010 Surgical Workforce Shortage Veterans Ophthalmology/Optometery Issues Oil Spill Health Effects Health Care in Rural Areas Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009 National Healthcare Workforce Commission Patient-Centered Outcomes Research Institute's Board of Governors Ambulatory Surgical Center Reimbursement HIT Meaningful Use Independent Payment Advisory Board/Health Care Reform

Client expense: $38,133 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

See page three for specific Medicare/Medicaid issues. H.R. 3590 - Patient Protection and Affordable Care Act H.R. 4872 - Health Care and Education Reconcilation Act of 2010 H.R. 4985 - Medicare Decisions Accountability Act of 2010 H.R. 4371 - Amend title XVIII/RVU for cardiology H.R. 5295 - Healthcare Truth and Transparency Act of 2010 H.R. 4851 - Continuing Extension Act of 2010 H.R. 4213 - American Jobs and Closing Tax Loopholes Act of 2010 Surgical Workforce Shortage Veterans Ophthalmology/Optometery Issues Oil Spill Health Effects Health Care in Rural Areas Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009 National Healthcare Workforce Commission Patient-Centered Outcomes Research Institute's Board of Governors Ambulatory Surgical Center Reimbursement HIT Meaningful Use Independent Payment Advisory Board/Health Care Reform

Client expense: $38,133 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Issues related to hospital readmissions/bundling and home infusion therapy coverage, (the Medicare Home Infusion Therapy Coverage Act of 2009 (HR 574/S 254)) The Comprehensive Immunosuppressive Drug Coverage for Transplant Patients Act (HR 1458/S 565) Issues related to Medicare physician payment system (to amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services, (HR 4371)), and CPT codes for myocardial perfusion imaging. The Health Care and Education Reconciliation Act of 2010 (HR 4872), the Patient Protection and Affordable Care (HR 3590), and the Affordable Health Care for America Act (HR 3962). Issues related to oncology coverage and medicare clinical trials (the Comprehensive Cancer Care Improvement Act of 2009 (HR 1844)).

Client expense: $430,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4851-Continuing Extension Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 H.R. 3962- Preservation of Access to Care for Medicare Beneficiaries & Pension Relief Act H.R. 4213- American Jobs, Closing Loopholes and Preventing Outsourcing Act 2011 Medicare Physician Fee Schedule Proposed Rule Health Care Truth and Transparency June 2010 Medpac Report to Congress-Aligning Incentives in Medicare H.R. 2575/S.3220 -Prosthetic and Custom Orthotic Parity Act of 2009 H.R. 2479- Medicare Orthotics and Prosthetics Improvement Act of 2009

Client expense: $160,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 43 and S. 46 - Medicare Access to Rehabilitative Services Act of 2009: Support and passage of all provisions, lobbying for the repeal of the provisions of the 1997 Balance Budget Act which imposed a $1840 annual cap on occupational therapy services covered by Medicare. HR 1094 - Medicare Home Health Flexibility Act of 2009: All provisions, passage, lobbying for changes to current regulations governing the provision of home health services under Medicare Part B to allow Occupational Therapy to qualify as an initiating service. HR 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009: lobbying against specific provisions in the legislation that would allow athletic trainers to bill Medicare as a therapy service incident to a physicians order. HR 2479 - Medicare Orthotics and Prosthetics Improvement Act of 2009: Oppose. Negatively impacts occupational therapy scope of practice. HR 2068 - Medicare Telehealth Expansion Act of 2009: Advocate for passage and inclusion of occupational therapy. S 1131/HR 2560 - Independence at Home Act of 2009: Support passage and inclusion of occupational therapy. HR 1829/S 950 - Medicare Patient Access to Physical Therapists Act of 2009: advocate for changing the bill to include occupational therapy. HR 3184/S 1186 - Medicare Independent Living Act: Advocate for passage No bill #: Health Care Reform; Educate about recommendations and position of the American Occupational Therapy Association regarding occupational therapy. HR 3200 - America's Affordable Health Choices Act of 2009: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy. HR 2891 - Access to Frontline Health Care Act of 2009: Support passage. HR 3590 (PL 111-148) - Patient Protection and Affordable Care Act: lobby regarding inclusion of occupational therapy, mental health coverage, and rehabilitation services; and in support of efforts to address shortages in health care workforce, including occupational therapy; and oppose Wyden Amendment D-9 offset related to orthotics and prosthetics; advocated to change Lincoln D-10 amendment to reduce the scope of the amendment and to include occupational therapy. HR4691 (PL 111-144) - Temporary Extensions Act of 2010: Advocate for extension of Medicare Therapy Caps Exceptions process and the Medicare Physicians Payment Update. HR 4851 (PL 111-157) - Continuing Extension Act of 2010: Advocate for extension of Medicare Physicians Payment Update. HR 3692 (PL 111-192) - Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010: Advocated for extension of Medicare Physicians Payment Update. Advocated for passage of short and long-term solutions to the Medicare Physician Fee Schedule payment cuts spurred by the Sustainable Growth Rate (SGR) formula. No Bill #: Advocate for extension of Medicare Therapy Caps Exceptions process. HR 3790 - To amend title XVIII of the Social Security Act to repeal the Medicare competitive acquisition program for durable medical equipment and prosthetics, orthotics, and supplies (DMEPOS) in a budget neutral manner: educated and advocated on impact on occupational therapy services. HR 5040 - Health Information Technology Extension for Behavioral Health Services Act of 2010: advocated for passage and educated about occupational therapy services. HR 1708 - Ending the Medicare Disability Waiting Period Act of 2009: Advocated for passage. HR 4993 - Home Health Care Planning Improvement Act of 2010: Advocated for passage and educated about occupational therapy services. S 3216 - Medicare Rural Health Care Equity Act of 2010: Advocated for passage. HR 4371 - A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services: Advocated regarding impact to occupational therapy services.

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

Government targets: Bureau of Labor Statistics (BLS), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA), White House Office

Issues related to CPT codes for Myocardial Perfusion Imaging; H. R. 4371; H. R. 1458, and S. 565, Comprehensive Immunosuppressive Drug coverage for Transplant Patients Act; H. R. 574 & S. 254, Medicare Home Infusion Therapy Coverage Act of 2009.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; Health Care Quality; Medical Imaging; Medicare reimbursement for cardiology. H.R. 4371, A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for cardiology services. Medicare Physician Payment Issues: H.R. 3962, Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 H.R.4213, American Jobs and Closing Tax Loopholes Act of 2010 H.R. 4851, Continuing Extension Act of 2010

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3962 Affordable Health Care Act for America H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010

Client expense: $180,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3962 Affordable Health Care Act for America H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010

Client expense: $180,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

Elimination of the Sustainable Growth Rate formula that impacts physician reimbursement. Advocated for passage of elimination in health reform bill HR 3590. Support for inclusion of an amendment to add Neurology to section 5501 of the health care bill, HR 3590. Oppose efforts to delay implementation of the Practice Expense Survey by CMS. Specifically oppose HR 4371.

Client expense: $141,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; Health Care Quality; Medical Imaging; Medicare reimbursement (practice expense); comparative effectiveness; radiation safety; Resource Use reports; Unapproved drugs initiative (nitroglycerin); Health Information Technology; HR 4371, a bill to revise practice expenses; S. 1796, America's Healthy Future Act of 2009; HR 3200, America's Affordable Health Choices Act; HR 3962, Affordable Health Care for America Act; HR 3590, Patient Protection and Affordable Care Act; HR 4872, the Health Care and Education Affordability and Reconcilation Act.

Client expense: $520,000 · Firm income: Not reported

Government targets: 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

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 (Medicare and Medicaid provisions, health plans and the exchange, National Health Service Corp, Byrd Amendment) H.R. 4371, to amend Title XVIII of the Social Security Act, all sections SGR - H.R. 3961, Medicare Physician Payment Reform Act, all sections H ReS. 1226, Resolution recognizing 25th Anniversary of Eye Care America Program

Client expense: $189,969 · Firm income: Not reported

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE, Veterans Affairs, Dept of (VA)

Support legislation to reduce cardiology cuts in 2010 Medicare Physician Fee Schedule final rule, including H.R. 4371; support legislation to reduce cardiology cuts in H.R. 3962, the Affordable Health Care for America Act, and H.R. 3590, the Patient Protection and Affordable Care Act; support and modify H.R. 3961, the Statutory Pay-As-You-Go Act of 2009, to reduce cardiology cuts.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2204, Medicare Access to Rural Anesthesiology Act: Rural Pass Through; S.1157, Craig Thomas Rural Hospital and Provider Equity Act of 2009; S.1776, Medicare Physician Fairness Act of 2009; H.R. 3961, Medicare Physician Payment Reform Act of 2009; Johnson Amendment, An amendment to H.R. 3200 to set Medicare payment rates for anesthesia services at a rate not less than the average paid by exchange participant health benefit plans. H.R. 4371, To amend the Social Security Act to continue using 2009 relative value units for certain cardiology services. Part B Medicare Physician's Fee Schedule: Implementation of Medicare Anesthesiology Teaching Funding Restoration Act H.R. 4851, The Continuing Extension Act of 2010 H.R. 4213, Tax Extenders Act of 2009 H.R. 4691, The Temporary Extension Act of 2010 H.J. res. 45 Statutory Pay-As-You-Go Act of 2010 H.R. 4872, The Health Care and Education Affordability and Reconciliation Act of 2010 2010 Medicare Physician Fee Schedule proposed and final rules Medicare Reform, Payment Issues: Physician Quality Reporting Initiative, Medicare Sustainable Growth Rate Physician Payment Update Scope of Practice Bundled payments CMS ACE Demonstration CMS Interpretive Guidelines CMS IPPS Medicare Payment CMS Physician Resource Use Reports CMS ICD-10 CMS Medicare Physician Practice Expense Relative Value Units CMS Hospital Outpatient Payment Proposed Rule CMS Hospital Acquired Conditions CMS Value-Based purchasing CMS Recovery Audit Contractors Program CMS Physician Practice Information Survey CMS Practicing Physicians' Advisory Council Nominations Medicaid Expansion: Provider payment levels Medicare Expansion, Ages 55-64 Independent Medicare Advisory Committee (IMAC) and Independent Medicare Advisory Board (IMAB) Balance billing MedPAC nominations CMS Handoffs Anesthesia Information Management System Accountable Care Organizations

Client expense: $210,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE

Issues related to hospital readmissions/bundling and home infusion therapy coverage, (the Medicare Home Infusion Therapy CoverageAct of 2009 (HR 574/S 254)) The Comprehensive Immunosuppressive Drug Coverage for Transplant Patients Act (HR 1458/S 565) Issues related to Medicare physician payment system (to amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services, (HR 4371)), and CPT codes for myocardial perfusion imaging. The Health Care and Education Reconciliation Act of 2010 (HR 4872), the Patient Protection and Affordable Care (HR 3590), and the Affordable Health Care for America Act (HR 3962). Issues related to oncology coverage and medicare clinical trials, the 21st Century Cancer ALERT ("Access to Life-Saving Early detection, Research and Treatment" Act (HR1844)).

Client expense: $700,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support legislation to reduce cardiology cuts in 2010 Medicare Physician Fee Schedule final rule, including H.R. 4371; support legislation to reduce cardiology cuts in H.R. 3962, the Affordable Health Care for America Act, and H.R. 3590, the Patient Protection and Affordable Care Act; support and modify H.R. 3961, the Statutory Pay-As-You-Go Act of 2009, to reduce cardiology cuts.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 43/S.46 - Medicare Access to Rehabilitation Services Act of 2009 H.R. 1137 - Athletic Trainers' Equal Access to Medicare Act of 2009 H.R. 1829/ S. 950 - Medicare Patient Access to Physical Therapists Act of 2009 H.R. 1430 - The Medicare Oral Health Rehabilitative Enhancement Act H.R. 2 - Children's Health Insurance Program Reauthorization Act of 2009 Revisions to the home health assessment instrument OASIS National Quality Forum home health quality measures Cardiac and Pulmonary Rehab national coverage policies AHRQ technical assessment of negative pressure wound therapy devices Comprehensive assessment regarding the development of HCPCS codes for negative pressure wound therapy (sign on) Analysis of the Inpatient Rehabilitation Condition of Participation (COP) on rehab agencies Importance of support personnel and related services under IDEA and ESEA. Development of a Plan to Transition to a Medicare Value-Based Purchasing (VBP) Program for Physician and Other Professional Services Issues Paper (comments) Changes to Medicare payment policies (STATS workgroup), development of short-term alternatives Section 427 of Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) Quality Measures Medically Unbelievable Edits (comments) DMEPOS Accreditation AMA Physician Consortium for Performance Improvement EMG performance Physical Medicine and Rehabilitation LCD (comments) Physician Quality Reporting Initiative Provider Enrollment Post Acute Care Issues Post Acute Care Payment Reform Demonstration, including development and testing of CARE tool Development of long term alternatives to the therapy cap - "Developing Outpatient Therapy Alternatives Project" (DOTPA) Medicare Orthotics and Prosthetics Physician Fee Schedule Update Sustainable Growth Rate (SGR) Inpatient Rehab Issues Medicaid Rules Self Referral H.R. 1094- The Medicare Home Health Flexibility Act Inclusion of Physical Therapists in the Medicare & Medicaid Health Information Technology incentives S. 1213- Patient Centered Outcomes Research Act of 2009 H.R. 2068- Medicare Telehealth Enhancement Act of 2009 H.R. 1094- Medicare Home Health Flexibility Act The Addition of a program to the Center for Medicare Services Innovation Center to research direct access models for expanding access to physical therapy for Medicare beneficiaries. Medicare SNF PPS FY 2010 Medicare IRF PPS FY 2010 Medicare Home Health PPS CY 2010 H.R. 3962 Affordable Health Care Act for America H.R. 3590 Patient Protection and Affordable Care Act Physician Practice Information Survey (PPIS) H.R. 4371- To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services. H.R. 4872- Health Care & Education Affordability Reconciliation Act H.R. 4691-Temporary Extension Act of 2010 H.R. 4851-Continuing Extension Act of 2010 H.R. 4231-Tax Extenders Act of 2010 H.R. 4154- American Workers State and Business Relief Act of 2010 H.R. 4662- Lymphedema Diagnosis and Treatment Cost Saving Act of 2010

Client expense: $180,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Education, Dept of, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Veterans Affairs, Dept of (VA), White House Office

HR 2697 Optometric Equity in Medicaid Act of 2009. HR 3590 Patient Protection and Affordable Care Act. HR 3961 Medicare Physician Payment Reform Act of 2009. HR 3962 Affordable Health Care for America Act. HR 4213 Tax Extenders Act of 2009. 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. HR 4851 Continuing Extension Act of 2010. HR 4872 Health Care and Education Reconciliation Act of 2010.

Client expense: $450,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 186 Glaucoma Screening Act of 2009. HR 228 To direct the Secretary of Veterans Affairs to establish a scholarship program for students seeking a degree or certificate in the areas of visual impairment and orientation and mobility. HR 577 Vision Care for Kids Act of 2009. HR1402 Catalyst to Better Diabetes Care Act of 2009. HR 1884 National Health Service Corps. HR 2697 Optometric Equity in Medicaid Act of 2009. HR 2350 Preserving Patient Access to Primary Care Act of 2009. HR 3590 Patient Protection and Affordable Care Act. HR 3961 Medicare Physician Payment Reform Act of 2009. HR 3962 Affordable Health Care for America Act. 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. HR 4872 Health Care and Education Reconciliation Act of 2010. S 259 Vision Care for Kids Act of 2009.

Client expense: $450,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See page three for specific Medicare/Medicaid issues. H. R. 3590 - Patient Protection and Affordable Care Act H. R. 4872 - Health Care and Education Reconciliation Act of 2010 H. R. 4985 - Medicare Decisions Accountability Act of 2010 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. J. RES. 45 - Increasing the statutory limit on the public debt H. R.4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services H. R. 4851 - Continuing Extension Act of 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 Surgical Workforce Shortage Truth and Transparency

Client expense: $5,580 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

See page five for specific health issues. H. R. 3590 - Patient Protection and Affordable Care Act H. R. 4872 - Health Care and Education Reconciliation Act of 2010 H. R. 4985 - Medicare Decisions Accountability Act of 2010 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. J. RES. 45 - Increasing the statutory limit on the public debt H. R.4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services H. R. 4851 - Continuing Extension Act of 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 Surgical Workforce Shortage Truth and Transparency

Client expense: $5,580 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

See page three for specific Medicare/Medicaid issues. H. R. 3590 - Patient Protection and Affordable Care Act H. R. 4872 - Health Care and Education Reconciliation Act of 2010 H. R. 4985 - Medicare Decisions Accountability Act of 2010 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. J. RES. 45 - Increasing the statutory limit on the public debt H. R.4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services H. R. 4851 - Continuing Extension Act of 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 Surgical Workforce Shortage Truth and Transparency

Client expense: $51,154 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

See page five for specific health issues. H. R. 3590 - Patient Protection and Affordable Care Act H. R. 4872 - Health Care and Education Reconciliation Act of 2010 H. R. 4985 - Medicare Decisions Accountability Act of 2010 H. R. 3961 - Medicare Physician Payment Reform Act of 2009 H. R. 3962 - Affordable Health Care for America Act H. J. RES. 45 - Increasing the statutory limit on the public debt H. R.4371 - To amend title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for certain cardiology services H. R. 4851 - Continuing Extension Act of 2010 H. R. 3693 - Ensuring the Future Physician Workforce Act of 2009 Surgical Workforce Shortage Truth and Transparency

Client expense: $51,154 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

Medicare physician payment; Health Care Quality; Medical Imaging; Medicare reimbursement for cardiology. H.R. 4371, A bill to amend Title XVIII of the Social Security Act to continue using 2009 Medicare practice expense relative value units for cardiology services. S. 1796, America's Healthy Future Act of 2009; H.R. 3200, America's Affordable Health Choices Act of 2009; H.R. 3962, Affordable Health Care for America Act; H.R. 3590, Patient Protection and Affordable Care Act H.R. 4872, The Health Care and Education Affordability and Reconciliation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE