Loading…
To suspend temporarily the duty on Disperse Blue 56.
Legislative Progress
Momentum (last 30 days)
0
score
0 actions · 0 new cosponsors · 0 votes
Speed vs cohort
37pct
6d open
vs 6,662 other HR bills in the 112th — cohort avg 39d
No CRS summary is available for this bill yet. The source title, actions, sponsors, and text versions below come from Congress.gov.
These links require the bill number to appear in the filing's source-reported specific issue text. Client expenses and lobbying-firm income are separate disclosure fields.
Filing registrants (26)
Bills with similar content found using semantic analysis.
Sources: Congress.gov
2012 · fourth_quarter · Medicare/Medicaid
H. R. 1063, S. 1718, The Strengthening Medicare and Repaying Taxpayers (SMART) Act. H.R. 5284, The Medicare Secondary Payer and Workers' Compensation Settlments Act of 2012. H.R. 1845 Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012, Title II, Strengthening Medicare Secondary Payer Rules. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA)
2012 · fourth_quarter · Health Issues
Implementation of H.R. 3590, The Patient Protection and Affordable Care Act Sections (P.L. 111-148) Title IIIImproving the Quality and Efficiency of Health Care; Implementation of the American Recovery and Reinvestment Act of 2009,(P.L. 111-5) Title XIII the Health Information Technology for Economic and Clinical Health Act (HITECH Act); H.R.3239, Safeguarding Access For Every Medicare Patient Act, all provisions. H.R. 6043: Behavioral Health Information Technology Act of 2012, all provisions. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $25,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA), White House Office
2012 · fourth_quarter · Health Issues
Establish and preserve accountable care organizations in California, preserve funding for certain Medicare Advantage plans; establish medical homes; establish CMS innovation center (H.R. 3962, Sec. 1301, 1302, 1907; Div. B. Title I, Subtitle D; Affordable Health Care for America Act. H.R. 3590, Sec. 3021, 3022, 9010; Part III, Subtitle C, Patient Protection and Affordable Care Act)
Client expense: Not reported · Firm income: $70,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · fourth_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the 26.5 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2013. Sequestration: October through December 2012, advocated strongly that Congress develop and pass a fiscally responsible, bipartisan agreement to prevent the implementation of across-the-board budget sequestration cuts that would endanger critical programs related to medical research, public health, workforce, food and drug safety, and health care for military families, as well as trigger cuts in Medicare payments to physicians and graduate medical education programs that will endanger patient access to care. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care. 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 Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate AHRQ. 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. 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 at or below 133 percent of the Federal Poverty Level and ensure fair payments to participating physicians, as enacted in the ACA; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation, H.R. 3667, would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Physician Fee Schedule/August 2012: Advocated on an on-going basis that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service.
2012 · fourth_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Advocated for halting the 26.5 percent cut in physician payments resulting from the flawed SGR formula, which was scheduled to take effect on January 1, 2013. Sequestration: October through December 2012, advocated strongly that Congress develop and pass a fiscally responsible, bipartisan agreement to prevent the implementation of across-the-board budget sequestration cuts that would endanger critical programs related to medical research, public health, workforce, food and drug safety, and health care for military families, as well as trigger cuts in Medicare payments to physicians and graduate medical education programs that will endanger patient access to care. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care. 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 Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate AHRQ. 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. 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 at or below 133 percent of the Federal Poverty Level and ensure fair payments to participating physicians, as enacted in the ACA; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Essential Health Benefits: Commented on the proposed rule regarding essential benefits, actuarial value, and accreditation as issued by the U.S. Department of Health & Human Services on November 20, 2012; Advocated that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation, H.R. 3667, would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Physician Fee Schedule/August 2012: Advocated on an on-going basis that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service.
Client expense: $254,554 · 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
Client expense: $122,487 · 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
2012 · fourth_quarter · Tariff (miscellaneous tariff bills)
H.R.3917:To extend the temporary suspension of duty on Disperse Red 60. H.R.3918 : To extend temporarily the suspension of duty on Disperse Yellow 64. H.R.3919 : To extend temporarily the suspension of duty on Vat Blue 66. H.R.3920 : To extend temporarily the suspension of duty on Acid Black 172. H.R.3921 : To extend temporarily the suspension of duty on Reactive Blue 224. H.R.3922 : To extend the temporary suspension of duty on Cuprate (4-). H.R.3923 : To suspend temporarily the duty on certain other made up articles. H.R.3924 : To extend temporarily the suspension of duty on Reactive Yellow 27. H.R.3925 : To extend temporarily the suspension of duty on Disperse Blue 77. H.R.3926 : To suspend temporarily the duty on other knitted or crocheted fabrics, of cotton, dyed, other, of single knit construction. H.R.3927 : To extend temporarily the suspension of duty on Solvent Yellow 163. H.R.3928 : To suspend temporarily the duty on 1H-Xantheno. H.R.3929 : To extend temporarily the suspension of duty on Reactive Red 123. H.R.3930 : To extend temporarily the suspension of duty on Reactive Black 5. H.R.3931 : To suspend temporarily the duty on Disperse Blue 284. H.R.3932 : To extend temporarily the suspension of duty on Reactive Red 198. H.R.3933 : To extend temporarily the suspension of duty on Acid Blue 324. H.R.3934 : To suspend temporarily the duty on Acid Yellow 151. H.R.3935 : To extend temporarily the suspension of duty on Acid Blue 221. H.R.3936 : To suspend temporarily the duty on Acid Yellow 137. H.R.3937 : To extend temporarily the suspension of duty on Acid Yellow 230. H.R.3938 : To extend temporarily the suspension of duty on Acid Red 414. H.R.3939 : To suspend temporarily the duty on mixtures of Disperse Red 367. H.R.3940 : To suspend temporarily the duty on Reduced Vat Blue 1. H.R.3941 : To suspend temporarily the duty on Acid Red 278. H.R.3942 : To suspend temporarily the duty on Direct Red 84. H.R.3943 : To suspend temporarily the duty on Acetic acid. H.R.3944 : To suspend temporarily the duty on Acid Yellow 7 H.R.3945 : To suspend temporarily the duty on Acid Blue 171. H.R.3946 : To suspend temporarily the duty on Reactive Blue 19. H.R.3947 : To suspend temporarily the duty on Disperse Yellow 184:1. H.R.3948 : To suspend temporarily the duty on Acid Red 182. H.R.3949 : To suspend temporarily the duty on mixtures of (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-2-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-6-(phenylamino)-) and (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-6-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-2-(phenylamino)-). H.R.3950 : To suspend temporarily the duty on Direct Green 91. H.R.3951 : To suspend temporarily the duty on Disperse Red 159. H.R.3952 : To suspend temporarily the duty on Reactive Red 122. H.R.3953 : To suspend temporarily the duty on mixtures of Cobaltate (2-) and Cobaltate (3-). H.R.3954 : To suspend temporarily the duty on Disperse Red 311. H.R.3955 : To suspend temporarily the duty on Reactive Blue 187. H.R.3956 : To suspend temporarily the duty on Disperse Yellow 71. H.R.3957 : To suspend temporarily the duty on mixtures of Acid Black 244, (Chromate(2-), (Cobaltate(1-), and (Chromate(1-). H.R.3958 : To suspend temporarily the duty on Acid Blue 284. H.R.3959 : To suspend temporarily the duty on Basic Blue 94:1. H.R.3960 : To suspend temporarily the duty on Disperse Orange 288. H.R.3961 : To suspend temporarily the duty on Disperse Blue 284. H.R.3962 : To suspend temporarily the duty on Disperse Blue 56. H.R.3963 : To suspend temporarily the duty on Acid Blue 264. H.R.3964 : To suspend temporarily the duty on mixtures of (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-hydroxyphenyl)-) and (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-methoxyphenyl)-). H.R.3965 : To suspend temporarily the duty on Acid Red 426. H.R.3966 : To suspend temporarily the duty on mixtures of Reactive Blue 250 and Reactive Black 5. H.R.3967 : To suspend temporarily the duty on mixtures of Reactive Black 5, Benzenesulfonic acid, and 1-Naphthalenesulfonic acid. H.R.3968 : To suspend temporarily the duty on mixtures of Disperse Red 367, Benzo, and Acetic acid. H.R.3969 : To suspend temporarily the duty on mixtures of Disperse Blue 77. H.R.3970 : To suspend temporarily the duty on mixtures of Reactive Red 198 and Reactive Red 239. H.R.3971 : To suspend temporarily the duty on mixtures of Reactive Blue 19. H.R.3972 : To suspend temporarily the duty on certain woven fabrics of cotton.
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · fourth_quarter · Health Issues
Health Insurance Individual Market H.R. 3962: Affordable Health Care for America Act H.R. 3200: America's Affordable Healthcare Choices Act Health Care Reform Medical Loss Ratio legislation H.R 3590: Patient Protection & Affordable Care Act Tax provision (m) 162-tax issue
Client expense: Not reported · Firm income: $10,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2012 · fourth_quarter · Food Industry (safety, labeling, etc.)
Monitor issues pertaining to the Dietary Supplement Health and Education Act (DSHEA). Affordable Health Care for America (H.R. 3962). Patient Protection and Affordable Care Act (PL 111-148). Monitor and explain impacts of NDI guidance issued by the FDA.
Client expense: Not reported · Firm income: $20,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE
2012 · third_quarter · Health Issues
Establish and preserve accountable care organizations in California, preserve funding for certain Medicare Advantage plans; establish medical homes; establish CMS innovation center (H.R. 3962, Sec. 1301, 1302, 1907; Div. B. Title I, Subtitle D; Affordable Health Care for America Act. H.R. 3590, Sec. 3021, 3022, 9010; Part III, Subtitle C, Patient Protection and Affordable Care Act)
Client expense: Not reported · Firm income: $100,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · third_quarter · Tariff (miscellaneous tariff bills)
H.R.3917:To extend the temporary suspension of duty on Disperse Red 60. H.R.3918 : To extend temporarily the suspension of duty on Disperse Yellow 64. H.R.3919 : To extend temporarily the suspension of duty on Vat Blue 66. H.R.3920 : To extend temporarily the suspension of duty on Acid Black 172. H.R.3921 : To extend temporarily the suspension of duty on Reactive Blue 224. H.R.3922 : To extend the temporary suspension of duty on Cuprate (4-). H.R.3923 : To suspend temporarily the duty on certain other made up articles. H.R.3924 : To extend temporarily the suspension of duty on Reactive Yellow 27. H.R.3925 : To extend temporarily the suspension of duty on Disperse Blue 77. H.R.3926 : To suspend temporarily the duty on other knitted or crocheted fabrics, of cotton, dyed, other, of single knit construction. H.R.3927 : To extend temporarily the suspension of duty on Solvent Yellow 163. H.R.3928 : To suspend temporarily the duty on 1H-Xantheno. H.R.3929 : To extend temporarily the suspension of duty on Reactive Red 123. H.R.3930 : To extend temporarily the suspension of duty on Reactive Black 5. H.R.3931 : To suspend temporarily the duty on Disperse Blue 284. H.R.3932 : To extend temporarily the suspension of duty on Reactive Red 198. H.R.3933 : To extend temporarily the suspension of duty on Acid Blue 324. H.R.3934 : To suspend temporarily the duty on Acid Yellow 151. H.R.3935 : To extend temporarily the suspension of duty on Acid Blue 221. H.R.3936 : To suspend temporarily the duty on Acid Yellow 137. H.R.3937 : To extend temporarily the suspension of duty on Acid Yellow 230. H.R.3938 : To extend temporarily the suspension of duty on Acid Red 414. H.R.3939 : To suspend temporarily the duty on mixtures of Disperse Red 367. H.R.3940 : To suspend temporarily the duty on Reduced Vat Blue 1. H.R.3941 : To suspend temporarily the duty on Acid Red 278. H.R.3942 : To suspend temporarily the duty on Direct Red 84. H.R.3943 : To suspend temporarily the duty on Acetic acid. H.R.3944 : To suspend temporarily the duty on Acid Yellow 7 H.R.3945 : To suspend temporarily the duty on Acid Blue 171. H.R.3946 : To suspend temporarily the duty on Reactive Blue 19. H.R.3947 : To suspend temporarily the duty on Disperse Yellow 184:1. H.R.3948 : To suspend temporarily the duty on Acid Red 182. H.R.3949 : To suspend temporarily the duty on mixtures of (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-2-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-6-(phenylamino)-) and (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-6-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-2-(phenylamino)-). H.R.3950 : To suspend temporarily the duty on Direct Green 91. H.R.3951 : To suspend temporarily the duty on Disperse Red 159. H.R.3952 : To suspend temporarily the duty on Reactive Red 122. H.R.3953 : To suspend temporarily the duty on mixtures of Cobaltate (2-) and Cobaltate (3-). H.R.3954 : To suspend temporarily the duty on Disperse Red 311. H.R.3955 : To suspend temporarily the duty on Reactive Blue 187. H.R.3956 : To suspend temporarily the duty on Disperse Yellow 71. H.R.3957 : To suspend temporarily the duty on mixtures of Acid Black 244, (Chromate(2-), (Cobaltate(1-), and (Chromate(1-). H.R.3958 : To suspend temporarily the duty on Acid Blue 284. H.R.3959 : To suspend temporarily the duty on Basic Blue 94:1. H.R.3960 : To suspend temporarily the duty on Disperse Orange 288. H.R.3961 : To suspend temporarily the duty on Disperse Blue 284. H.R.3962 : To suspend temporarily the duty on Disperse Blue 56. H.R.3963 : To suspend temporarily the duty on Acid Blue 264. H.R.3964 : To suspend temporarily the duty on mixtures of (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-hydroxyphenyl)-) and (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-methoxyphenyl)-). H.R.3965 : To suspend temporarily the duty on Acid Red 426. H.R.3966 : To suspend temporarily the duty on mixtures of Reactive Blue 250 and Reactive Black 5. H.R.3967 : To suspend temporarily the duty on mixtures of Reactive Black 5, Benzenesulfonic acid, and 1-Naphthalenesulfonic acid. H.R.3968 : To suspend temporarily the duty on mixtures of Disperse Red 367, Benzo, and Acetic acid. H.R.3969 : To suspend temporarily the duty on mixtures of Disperse Blue 77. H.R.3970 : To suspend temporarily the duty on mixtures of Reactive Red 198 and Reactive Red 239. H.R.3971 : To suspend temporarily the duty on mixtures of Reactive Blue 19. H.R.3972 : To suspend temporarily the duty on certain woven fabrics of cotton.
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · third_quarter · Medicare/Medicaid
H. R. 1063, S. 1718, The Strengthening Medicare and Repaying Taxpayers (SMART) Act. H.R. 5284, The Medicare Secondary Payer and Workers' Compensation Settlments Act of 2012. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA)
2012 · third_quarter · Health Issues
Implementation of H.R. 3590, The Patient Protection and Affordable Care Act Sections (P.L. 111-148) Title IIIImproving the Quality and Efficiency of Health Care; Implementation of the American Recovery and Reinvestment Act of 2009,(P.L. 111-5) Title XIII the Health Information Technology for Economic and Clinical Health Act (HITECH Act); H.R.3239, Safeguarding Access For Every Medicare Patient Act, all provisions. H.R. 6043: Behavioral Health Information Technology Act of 2012, all provisions. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $25,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA), White House Office
2012 · third_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost;. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. 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 Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate the Agency for Healthcare Research and Quality. 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. 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. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Hospital Outpatient Proposed Rule/August 2012: ACP expressed concern to CMS of the increased frequency of beneficiaries in hospital settings being categorized as outpatients receiving observation services rather than regular inpatient admissions; recommended current general admission criteria be replaced or at least clarified through the use of the large number of evidence based guidelines covering a variety of conditions frequently involved in the hospitalization decision-making process (e.g., chest pain, heart failure, chronic obstructive pulmonary disease) offered through the Agency for Healthcare Research and Quality (AHRQ) National Guidelines Clearinghouse, the opinion of the admitting physician be given increased weight in the coverage determination process, prior to any denial of admission by a Medicare contractor, the denial should be reviewed and confirmed by a physician, need improved clear and transparent inpatient admission criteria. Health Information Technology/August 2012: Provided suggestions on Stage 3 of Meaningful Use, including: Refine and evolve existing measures rather than add new measures; do not introduce new functions without appropriate testing; choose additional documentation requirements wisely and seek to reduce existing requirements that do not add value to the patient record; require usability testing with a specific focus on reducing data collection burdens; do not add functional requirements that have not been adequately defined; understand the implications of intensively focusing vendors programming capacity on Meaningful Use requirements. Physician Fee Schedule/August 2012: Advocated that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service. Sequestration: Opposed automatic across-the-board cuts (known as sequestration) scheduled to hit federal agencies in January 2013 to the tune of $100 billion. Across-the-board cuts, which do not take into consideration the importance or effectiveness of any particular program or activity, are not an appropriate method of governing. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care.
Client expense: $266,710 · 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
2012 · third_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. In July 2012 testimony; advocated for the Patient-Centered Medical Home model should be scaled up for broad Medicare adoption, recognized, through the medical neighborhood concept, that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentivesboth non-financial and financialfor engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care; advocated for ACPs High Value, Cost-Conscious Care Initiative, which includes clinical, public policy, and educational components, designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. 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 Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013; Urged Congress not to terminate the Agency for Healthcare Research and Quality. 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. 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. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Hospital Outpatient Proposed Rule/August 2012: ACP expressed concern to CMS of the increased frequency of beneficiaries in hospital settings being categorized as outpatients receiving observation services rather than regular inpatient admissions; recommended current general admission criteria be replaced or at least clarified through the use of the large number of evidence based guidelines covering a variety of conditions frequently involved in the hospitalization decision-making process (e.g., chest pain, heart failure, chronic obstructive pulmonary disease) offered through the Agency for Healthcare Research and Quality (AHRQ) National Guidelines Clearinghouse, the opinion of the admitting physician be given increased weight in the coverage determination process, prior to any denial of admission by a Medicare contractor, the denial should be reviewed and confirmed by a physician, need improved clear and transparent inpatient admission criteria. Health Information Technology/August 2012: Provided suggestions on Stage 3 of Meaningful Use, including: Refine and evolve existing measures rather than add new measures; do not introduce new functions without appropriate testing; choose additional documentation requirements wisely and seek to reduce existing requirements that do not add value to the patient record; require usability testing with a specific focus on reducing data collection burdens; do not add functional requirements that have not been adequately defined; understand the implications of intensively focusing vendors programming capacity on Meaningful Use requirements. Physician Fee Schedule/August 2012: Advocated that policies to improve payment for undervalued evaluation and management services should not be restricted to a designated subset of specialties (as defined by their self-designation) or impose other restrictive criteria that could exclude physicians who legitimately and appropriately provide such services to their patients. Rather, the objective should be to pay more appropriately for evaluation and care coordination services that bring value to the patient, no matter the specialty of the physician who is billing for the service. Sequestration: Opposed automatic across-the-board cuts (known as sequestration) scheduled to hit federal agencies in January 2013 to the tune of $100 billion. Across-the-board cuts, which do not take into consideration the importance or effectiveness of any particular program or activity, are not an appropriate method of governing. Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs. They should work to improve the effectiveness of care provided, make necessary and appropriate changes in entitlement programs, including Medicare cost-sharing, reform payment and delivery systems, and support the proven value of primary care.
Client expense: $143,679 · 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
2012 · third_quarter · Medicare/Medicaid
The following bullet points summarize the objectives of the Marshfield Clinics Health Policy Agenda: value-based purchasing of health services including bonus payments for high value Medicare Advantage programs; establishment and funding of comparative effectiveness research; promoting payment fairness in Medicare physician and practice expense payments; new formulas for aligning Medicare reimbursement with value; bonus payments for efficient providers; bonus payments for primary care providers; financing for the adoption and utilization of health information technology; repeal and reform of the Medicare sustainable growth rate mechanism for updating physician payments; improved reimbursement for the CMS Physician Group Practice (PGP) demonstration; expansion of the PGP demonstration methodology into a national accountable care organization program to extend the physician group practice demonstration; Adequate funding for CMS; Adequate funding for community health centers; Funding for after-school programs Integration of Medical and dental care and records Meaningful use of HIT; Funding for medical simulation training Personalized medicine Healthy lifestyles programs Medicare Pay for Value Provider accountability for quality and spending growth is an essential element of delivery system reform. CMS is presently developing rules to implement a budget neutral value modifier for physician reimbursement modeled after pay for performance concepts. Quality measures for physicians and other providers are being refined and converging with the quality measures identified for the HIT meaningful use incentive program. The proposed rule for the physician value modifier is expected July 1. Marshfield Clinic has utilized its proprietary medical record to implement population health protocols which have successfully improved performance on CMS's Physician Group Practice Demonstration quality metrics while reducing costs for the care of a risk adjusted population. The Clinic intends to continue its participation in CMS's shared savings program as an Accountable Care Organization. Medicares Sustainable Growth Rate We believe that the longstanding challenges inherent in fee for service reimbursement under the resource based relative value system, and the financial problems associated with the sustainable growth rate (SGR) formula must be addressed to assure access to Medicare benefits and the future solvency of the Medicare program. We recommend that Congress repeal the SGR formula, and link future updates to measures that reflect the cost and value of providing health care services. Congress must also take steps immediately to create increased incentives for preventative care, care coordination, and primary care services. Physician spending is currently only a fraction of total health care spending but it affects nearly all other aspects of health care delivery. We recommend that Congress utilize the leverage of physician spending to deal with the misaligned incentives in the Medicare program that lead to higher costs and inefficiencies throughout the spectrum of health care delivery. Medicare Advantage Performance Measurement The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Security Health Plan of Wisconsin, Inc., was one of only two health plans in the nation to be recognized for the second year in a row with the highest rating of 5 stars from the Centers for Medicare and Medicaid Services (CMS) for its Advocare Medicare Advantage plans for 2012. Only eight other plans across the nation this year received a 5-star rating from CMS. The ratings, now available on the Medicare website, are the result of an annual assessment by CMS of Medicare health plans' clinical quality, consumer satisfaction and other beneficiary experience areas. Affordable Care Act If the Supreme Court repeals all or part of the Affordable Care Act, Marshfield Clinic will continue on its current trajectory and mission serving patients though accessible, high quality, health care, research and education. If any portion of the law is repealed we would urge Congress to work swiftly to shore up the gaps in coverage to preserve universal access to health care services. Budget Control Act (S. 365, PL 112-25) provisions requiring mandatory sequestration of federal funding if Congress does not act to implement deficit reduction. Medicare Payment Advisory Commission recommendations regarding reform of the Sustainable Growth Rate (SGR) formula of the Medicare physician fee schedule, and offsets to fund the reforms. H.R.3682 : Patient Centered Healthcare Savings Act of 2011 Sponsor: Rep Duffy, Sean P. - Marshfield Clinic, the corporate sponsor of Security Health Plan, a five star Medicare Advantage program, opposes provisions which promote the sale of insurance across state lines but do not address the disparities in existing state law which would allow other insurance entities to circumvent Wisconsin law. Value Based Purchasing The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. Recommendations: Medicare and other payors must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Variations in Health Care Service and Distribution Research conducted the Medicare Payment Advisory commission and the Dartmouth School of Medicine has documented glaring variations in how medical resources are distributed and used in the United States. Medicare pays many hospitals and their doctors much more than what it pays the most efficient and effective health care institutions to treat chronically ill people, yet they still get worse results. The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should lead us to ask if some chronically ill Americans are getting more care than they actually want or need. Caring for people with chronic disease now accounts for more than 75 percent of all health-care spending. Over-use and overspending is not just a Medicare problemthe health-care system as a whole lacks efficient, effective ways of caring for people with severe chronic illnesses. If the U.S. health care system mirrored the practice patterns of the most efficient/effective health care institutions, Medicare and other payors could save billions of dollars annually. Sustainable Growth Rate Medicares SGR mechanism unfairly links physician payment updates to factors unrelated to patients needs and the cost of providing patient care. For years the Marshfield Clinic has watched Medicare physician payments atrophy in proportion to the cost of providing Medicare Services. In 2010 the Clinic recovered only 52.45% of the Medicare Allowable Costs of serving Medicare patients. In 2009 the Clinic lost 49.6 cents on each dollar of care provided. As payments have deteriorated in both the Medicare and Medicaid sector, the Clinic has documented increasing patient counts as other physicians and providers in the communities that we serve turn patients away. The difficulty of correctly updating physician fees is complicated by problems with the fee schedule regarding resource use, compensation for care coordination, and volume growth that point to Mispricing related to the value of physician services; inaccuracy of practice expense (overhead) calculations; and increasing variation in the volumes of services provided in different regions of the country. Uncertainty about the Medicare/Medicaid revenue stream complicates Clinic efforts to provide services where they are needed. Stability, adequacy, and predictability in payment should be the highest priority for Congress to assure high quality efficient care for all patients, but especially for the 20% of the population that is chronically ill and responsible for 75% of Medicare spending. Medicare Payment Inequities In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. The Update formula for physician services is inequitable because it treats all physicians and regions of the country alike regardless of their individual volume influencing behavior. If the problem of cost is related to the volume of services provided, shouldnt payment be volume adjusted for specific localities? Why should conservative practices and States be punished for the excessive volume of other localities? Payment Equity for Physician Work There is no difference in the work of physicians in different locations regardless of where the work occurs. We believe that physician work should not be adjusted for geographic location. What is the rational for paying physicians more in many geographic areas when those same areas have apparently ample numbers of physicians and their wages are trending below physician wages in other areas? Should the Medicare program subsidize physicians who chose to live in high cost areas? Recommendation: the geographic adjustment of physician work should be eliminated entirely on a Budget neutral basis. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Medicares physician fee schedule, which specifies the amount that Medicare will pay for each physician service, includes adjustments that are ostensibly made to ensure that the fees paid reflect systematic and enduring variation in geographic practice-related costs. Currently, CMS uses the median hourly earnings of four occupational classes -- Clerical Workers, Registered Nurses, Licensed Practical Nurses, and Medical Technicians -- found in physician offices as proxy non-physician wage input cost measures. These proxy occupational classes, which were the most common employees in physician practices in the 1980s, are now only a subset of non-physician employees in physician practices. The practice of medicine has changed substantially since the proxy measurement formulae were established. Recommendation: Congress should require CMS to administratively revise its measurement of cost of practice to assure the validity and fairness of payments. Medicare Advantage The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Accountable Care Organizations One important delivery system reform is the Medicare Shared Savings Program under section 3022 of the Affordable Care Act, which promotes the formation and operation of accountable care organizations (ACOs). Under this provision, groups of providers meeting the criteria specified by the Secretary may work together to manage and coordinate care for Medicare beneficiaries through an [ACO]. An ACO may receive payments for shared savings if the ACO meets certain quality performance standards and cost savings requirements established by the Secretary. The basic shared savings model outlined in the statute provides a bonus payment to ACOs that meet quality targets and keep spending for the population for whom the ACO is responsible below a target level. The amount of the bonus payment will depend on the amount of savings and the proportion of the savings allocated to the ACO and Medicare ACOs should report a focused set of quality indicators that reflect the outcomes ACOs are designed to achieve: keeping the population healthy, better care coordination to reduce unnecessary and sometimes harmful spending, and better patient experience. New measures may be necessary for ACOs because the current measures reflect the limitations and incentives of the current FFS payment system. A focused set of measures would help assure Medicare that the ACO is doing its job and help assure beneficiaries that they are receiving high quality care. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulae to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulae measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Community Health Centers Under Health Reform The Affordable Care Act included provisions relating to community health centers, including $11 billion in new funding for the community health center program over the next five years and $1.5 billion over the next five years to expand the National Health Service Corp. While these are mandatory funding levels, it is possible that the Congress might cut the base funding levels for community health centers and the National Health Service Corp effectively diminishing the impact of the reform legislation. As reform is rolled out there are key payment protections and improvements for community health centers. For example, the Act requires that health centers receive no less than their Medicaid rate from private insurers offering plans through the new health insurance exchanges and it requires that these plans must contract with health centers. Other provisions add preventive services to the federally qualified health center Medicare payment rate and eliminates the outdated Medicare payment cap on FQHC payments. This will begin to modernize the health center Medicare payments to insure health centers are able to provide highest quality care to Medicare beneficiaries. Historically, Family Health Center and Marshfield Clinic have not attempted to access cost-based reimbursement under Medicare because of these payment caps. Dental Access and Integration with Traditional Medicine The Institute of Medicine (IOM) released a report, Dental Education at the Crossroads: Challenges and Change in January 1995 which called for a strong cohesion between medicine and dentistry. The IOM report states that "Dentistry will and should become more closely integrated with medicine and the health care system on all levels: research, education, and patient care. The National Institutes of Health has supported research documenting the importance of oral health in the context of general health and well being. Studies have demonstrated numerous oral-systemic interactions that underscore the need for more integrated care delivery. As our nation embraces EHR technologies, science underscores the need to fully incorporate oral health within an integrated EHR. Marshfield Clinic is simultaneously addressing the issue of dental access and integration with traditional medicine. Family Health Center of Marshfield, Inc. (FHC) in partnership with Marshfield Clinic has been serving low-income, underinsured and uninsured individuals since March 1974. Using technology to integrate medical and dental health records holds great promise to improve the quality, safety, efficiency, effectiveness and continuity of patient care by enhancing communication and teamwork between physicians and dentists. A comprehensive approach to primary care delivery, demonstrated by Marshfield Clinic and community health centers nationwide, can best be supported with an equally comprehensive EHR infrastructure for both medical and dental records. Meaningful Use of Health Information Technology The accelerating growth in new medical knowledge, coupled with the birth of new sciences, such as genomics and personalized medicine, suggests that physicians, nurses, and other healthcare professionals will invariably continue to fall further and further behind in their ability to keep up with the latest discoveries and approved treatments. As information technology has sparked this explosive growth in knowledge, only information technology can provide an adequate response. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare. Health IT on a broad basis is still in its infancy. Looking to what can be achieved in the future due to implementation of these systems should be our focus, and an ongoing oversight function of the Office of the National Coordinator for HIT which must be closely integrated with Medicare reimbursement. Personalized Medicine Personalized medicine is the concept that envisions an individually tailored approach to detecting, preventing, and treating disease based on a persons specific genetic profile. If the multiple population groups in the United States and elsewhere in the world are to benefit fully and fairly from such research, a national resource operated as a trust for the public good must be established to conduct a large populationbased cohort study that includes full representation of minority populations. Marshfield Clinic has developed a comprehensive bio-bank, consisting of DNA samples from 20,000+ individuals. The samples, often from extended families, have been linked electronically to medical records for more than 20 years of medical history. Further development of this public health infrastructure is in the national interest. The Federal government should make critical investments in the enabling tools and resources essential to moving beyond genomic discoveries to personalized medicine services of patient and public benefit. Medicaid Block Grants On March 29, the House approved Rep. Paul Ryans budget proposal for FY 2013, entitled "The Path to Prosperity. Ryan's proposal does not have the force of law but of special interest is Ryans proposal for Medicaid block grants which will come before the Energy and Commerce Committee. Under the Ryan proposal, starting in 2013, the federal share of all Medicaid payments would be paid to the states as a block grant. Chairman Ryan has projected savings to federal government that would result from reduced funding to states. Premium support On March 29, the House approved Rep. Paul Ryans budget proposal for FY 2013, entitled "The Path to Prosperity. Ryan's budget does not have the force of law but tees up consideration of various reform proposals which may be considered later this year. With regard to health care, the Ryan plan calls for a major withdrawal of the federal government from the financing of health care. One health provision of the proposal calls for conversion of the current Medicare to a premium support program. For people now 55 or younger, the traditional Medicare program a defined benefit plan would cease to exist and, starting in 2023, would be converted to a defined contribution program which has been described as a premium support program. Practice expense geographic practice cost index (GPCI) adjustment: Retroactively effective from Jan. 1, 2010, HHS is required to revise the calculation method of the practice expense (PE) portion of the GPCI. This revision results in increased PE GPCIs for certain rural areas Statutory provisions to extend these additional payments lapse in 2012 and must be extended for 2013. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services initially published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic was selected by CMS to participate in the demonstration program, effective April 1, 2005 and has been involved as a participant working with CMS ever since. Marshfield Clinic supports CMS determination to extend this program, and transition these organizations into Accountable care Organizations. Section 1301 of the House bill HR 3962, the Affordable Health Care for America Act, and Section 3022 of the Senate bill HR 3590, the Patient Protections and Affordable Care Act.
Client expense: $130,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, White House Office
2012 · third_quarter · Health Issues
Health Insurance Individual Market H.R. 3962: Affordable Health Care for America Act H.R. 3200: America's Affordable Healthcare Choices Act Health Care Reform Medical Loss Ratio legislation H.R. 3590: Patient Protection & Affordable Care Act Tax provision (m) 162-tax issue
Client expense: Not reported · Firm income: $10,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2012 · third_quarter · Food Industry (safety, labeling, etc.)
Monitor issues pertaining to the Dietary Supplement Health and Education Act (DSHEA). Affordable Health Care for America (H.R. 3962). Patient Protection and Affordable Care Act (PL 111-148). Monitor and explain impacts of NDI guidance issued by the FDA.
Client expense: Not reported · Firm income: $20,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE
2012 · second_quarter · Health Issues
Implementation of H.R. 3590, The Patient Protection and Affordable Care Act Sections (P.L. 111-148) Title IIIImproving the Quality and Efficiency of Health Care; Implementation of the American Recovery and Reinvestment Act of 2009,(P.L. 111-5) Title XIII the Health Information Technology for Economic and Clinical Health Act (HITECH Act); H.R.3239, Safeguarding Access For Every Medicare Patient Act, all provisions. H.R. 6043: Behavioral Health Information Technology Act of 2012, all provisions. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $25,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA), White House Office
2012 · second_quarter · Medicare/Medicaid
H. R. 1063, S. 1718, The Strengthening Medicare and Repaying Taxpayers (SMART) Act. H.R. 5284, The Medicare Secondary Payer and Workers' Compensation Settlments Act of 2012. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA)
2012 · second_quarter · Health Issues
Establish and preserve accountable care organizations in California, preserve funding for certain Medicare Advantage plans; establish medical homes; establish CMS innovation center (H.R. 3962, Sec. 1301, 1302, 1907; Div. B., Title I, Subtitle D; Affordable Health Care for America Act. H.R. 3590, Sec. 3021, 3022, 9010; Part III, Subtitle C, Patient Protection and Affordable Care Act)
Client expense: Not reported · Firm income: $100,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · second_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost; Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. 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 Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013. 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. 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. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians.
Client expense: $312,393 · 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
2012 · second_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost; Urged enactment of the Medicare Physician Payment Innovation Act (H.R. 5707), as introduced on May 9 by Representatives Allyson Schwartz (D-PA) and Joe Heck (R-NV). This legislation would eliminate the SGR once and for all and transition to better payment and delivery systems that are aligned with value. Specifically, H.R. 5707 would repeal the SGR formula, provide more than 5 years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services, and establishes a process for practices to transition to new, more effective, models of care by 2018. 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 Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. Fund the National Institutes of Health (NIH), at $32 billion, which represents the minimum investment necessary to avoid further loss of promising research and at the same time allows the NIH's budget to keep pace with biomedical inflation. Fund the Centers for Disease Control (CDC), at $7.8 billion, which reflects the minimal amount CDC will need to fulfill its core missions for fiscal year 2013, which are essential to protect the health of the American people. Preserve funding for GME in FY 2013. 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. 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. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated for the Empowering States to Innovate Act (S. 248, H.R. 844): This legislation would amend the ACA by moving up by three years (from 2017 to 2014) a provision in the ACA that already allows states to opt out of most of the laws mandates if they can develop a program that offers comparable coverage to their residents. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians.
Client expense: $133,400 · 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
2012 · second_quarter · Tariff (miscellaneous tariff bills)
H.R.3917:To extend the temporary suspension of duty on Disperse Red 60. H.R.3918 : To extend temporarily the suspension of duty on Disperse Yellow 64. H.R.3919 : To extend temporarily the suspension of duty on Vat Blue 66. H.R.3920 : To extend temporarily the suspension of duty on Acid Black 172. H.R.3921 : To extend temporarily the suspension of duty on Reactive Blue 224. H.R.3922 : To extend the temporary suspension of duty on Cuprate (4-). H.R.3923 : To suspend temporarily the duty on certain other made up articles. H.R.3924 : To extend temporarily the suspension of duty on Reactive Yellow 27. H.R.3925 : To extend temporarily the suspension of duty on Disperse Blue 77. H.R.3926 : To suspend temporarily the duty on other knitted or crocheted fabrics, of cotton, dyed, other, of single knit construction. H.R.3927 : To extend temporarily the suspension of duty on Solvent Yellow 163. H.R.3928 : To suspend temporarily the duty on 1H-Xantheno. H.R.3929 : To extend temporarily the suspension of duty on Reactive Red 123. H.R.3930 : To extend temporarily the suspension of duty on Reactive Black 5. H.R.3931 : To suspend temporarily the duty on Disperse Blue 284. H.R.3932 : To extend temporarily the suspension of duty on Reactive Red 198. H.R.3933 : To extend temporarily the suspension of duty on Acid Blue 324. H.R.3934 : To suspend temporarily the duty on Acid Yellow 151. H.R.3935 : To extend temporarily the suspension of duty on Acid Blue 221. H.R.3936 : To suspend temporarily the duty on Acid Yellow 137. H.R.3937 : To extend temporarily the suspension of duty on Acid Yellow 230. H.R.3938 : To extend temporarily the suspension of duty on Acid Red 414. H.R.3939 : To suspend temporarily the duty on mixtures of Disperse Red 367. H.R.3940 : To suspend temporarily the duty on Reduced Vat Blue 1. H.R.3941 : To suspend temporarily the duty on Acid Red 278. H.R.3942 : To suspend temporarily the duty on Direct Red 84. H.R.3943 : To suspend temporarily the duty on Acetic acid. H.R.3944 : To suspend temporarily the duty on Acid Yellow 7 H.R.3945 : To suspend temporarily the duty on Acid Blue 171. H.R.3946 : To suspend temporarily the duty on Reactive Blue 19. H.R.3947 : To suspend temporarily the duty on Disperse Yellow 184:1. H.R.3948 : To suspend temporarily the duty on Acid Red 182. H.R.3949 : To suspend temporarily the duty on mixtures of (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-2-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-6-(phenylamino)-) and (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-6-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-2-(phenylamino)-). H.R.3950 : To suspend temporarily the duty on Direct Green 91. H.R.3951 : To suspend temporarily the duty on Disperse Red 159. H.R.3952 : To suspend temporarily the duty on Reactive Red 122. H.R.3953 : To suspend temporarily the duty on mixtures of Cobaltate (2-) and Cobaltate (3-). H.R.3954 : To suspend temporarily the duty on Disperse Red 311. H.R.3955 : To suspend temporarily the duty on Reactive Blue 187. H.R.3956 : To suspend temporarily the duty on Disperse Yellow 71. H.R.3957 : To suspend temporarily the duty on mixtures of Acid Black 244, (Chromate(2-), (Cobaltate(1-), and (Chromate(1-). H.R.3958 : To suspend temporarily the duty on Acid Blue 284. H.R.3959 : To suspend temporarily the duty on Basic Blue 94:1. H.R.3960 : To suspend temporarily the duty on Disperse Orange 288. H.R.3961 : To suspend temporarily the duty on Disperse Blue 284. H.R.3962 : To suspend temporarily the duty on Disperse Blue 56. H.R.3963 : To suspend temporarily the duty on Acid Blue 264. H.R.3964 : To suspend temporarily the duty on mixtures of (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-hydroxyphenyl)-) and (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-methoxyphenyl)-). H.R.3965 : To suspend temporarily the duty on Acid Red 426. H.R.3966 : To suspend temporarily the duty on mixtures of Reactive Blue 250 and Reactive Black 5. H.R.3967 : To suspend temporarily the duty on mixtures of Reactive Black 5, Benzenesulfonic acid, and 1-Naphthalenesulfonic acid. H.R.3968 : To suspend temporarily the duty on mixtures of Disperse Red 367, Benzo, and Acetic acid. H.R.3969 : To suspend temporarily the duty on mixtures of Disperse Blue 77. H.R.3970 : To suspend temporarily the duty on mixtures of Reactive Red 198 and Reactive Red 239. H.R.3971 : To suspend temporarily the duty on mixtures of Reactive Blue 19. H.R.3972 : To suspend temporarily the duty on certain woven fabrics of cotton.
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · second_quarter · Health Issues
Health Insurance Individual Market H.R. 3962: Affordable Health Care for America Act H.R. 3200: America's Affordable Healthcare Choices Act Health Care Reform Medical Loss Ratio legislation H.R. 3590: Patient Protection & Affordable Care Act Tax provision (m) 162-tax issue
Client expense: Not reported · Firm income: $10,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2012 · second_quarter · Food Industry (safety, labeling, etc.)
Monitor issues pertaining to the Dietary Supplement Health and Education Act (DSHEA). Affordable Health Care for America (H.R. 3962). Patient Protection and Affordable Care Act (PL 111-148). Monitor and explain impacts of NDI guidance issued by the FDA.
Client expense: Not reported · Firm income: $20,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE
2012 · first_quarter · Health Issues
Supported Association/Small Business Health Plan Legislation. Opposed the Patient Protection and Affordable Care Act (H.R. 3590/H.R. 3962). Urged repeal of requirements in PPACA for businesses to file 1099 tax form for purchases from any vendor exceeding $600 anually. Supported the American Jobs Protection Act (H.R. 1744/S. 20) and other offers to eliminate the employer mandate. Supported H.R. 1370 and additional efforts to repeal health insurance tax.
Client expense: $428,630 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Intl Trade Administration (ITA), SENATE, U.S. International Trade Commission (ITC)
2012 · first_quarter · Medicare/Medicaid
H. R. 1063, S. 1718, The Strengthening Medicare and Repaying Taxpayers (SMART) Act. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA)
2012 · first_quarter · Medicare/Medicaid
H. R. 1063, S. 1718, The Strengthening Medicare and Repaying Taxpayers (SMART) Act. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $20,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA)
2012 · first_quarter · Tariff (miscellaneous tariff bills)
H.R.3917: To extend the temporary suspension of duty on Disperse Red 60. H.R.3918: To extend temporarily the suspension of duty on Disperse Yellow 64. H.R.3919: To extend temporarily the suspension of duty on Vat Blue 66. H.R.3920: To extend temporarily the suspension of duty on Acid Black 172. H.R.3921: To extend temporarily the suspension of duty on Reactive Blue 224. H.R.3922: To extend the temporary suspension of duty on Cuprate (4-). H.R.3923: To suspend temporarily the duty on certain other made up articles. H.R.3924: To extend temporarily the suspension of duty on Reactive Yellow 27. H.R.3925: To extend temporarily the suspension of duty on Disperse Blue 77. H.R.3926: To suspend temporarily the duty on other knitted or crocheted fabrics, of cotton, dyed, other, of single knit construction. H.R.3927: To extend temporarily the suspension of duty on Solvent Yellow 163. H.R.3928: To suspend temporarily the duty on 1H-Xantheno. H.R.3929: To extend temporarily the suspension of duty on Reactive Red 123. H.R.3930: To extend temporarily the suspension of duty on Reactive Black 5. H.R.3931: To suspend temporarily the duty on Disperse Blue 284. H.R.3932: To extend temporarily the suspension of duty on Reactive Red 198. H.R.3933: To extend temporarily the suspension of duty on Acid Blue 324. H.R.3934: To suspend temporarily the duty on Acid Yellow 151. H.R.3935: To extend temporarily the suspension of duty on Acid Blue 221. H.R.3936: To suspend temporarily the duty on Acid Yellow 137. H.R.3937: To extend temporarily the suspension of duty on Acid Yellow 230. H.R.3938: To extend temporarily the suspension of duty on Acid Red 414. H.R.3939: To suspend temporarily the duty on mixtures of Disperse Red 367. H.R.3940: To suspend temporarily the duty on Reduced Vat Blue 1. H.R.3941: To suspend temporarily the duty on Acid Red 278. H.R.3942: To suspend temporarily the duty on Direct Red 84. H.R.3943: To suspend temporarily the duty on Acetic acid. H.R.3944: To suspend temporarily the duty on Acid Yellow 7 H.R.3945: To suspend temporarily the duty on Acid Blue 171. H.R.3946: To suspend temporarily the duty on Reactive Blue 19. H.R.3947: To suspend temporarily the duty on Disperse Yellow 184:1. H.R.3948: To suspend temporarily the duty on Acid Red 182. H.R.3949: To suspend temporarily the duty on mixtures of (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-2-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-6-(phenylamino)-) and (3-Pyridinecarbonitrile, 5-[(2-cyano-4-nitrophenyl)diazenyl]-6-[[2-(2-hydroxyethoxy) ethyl]amino]-4-methyl-2-(phenylamino)-). H.R.3950: To suspend temporarily the duty on Direct Green 91. H.R.3951: To suspend temporarily the duty on Disperse Red 159. H.R.3952: To suspend temporarily the duty on Reactive Red 122. H.R.3953: To suspend temporarily the duty on mixtures of Cobaltate (2-) and Cobaltate (3-). H.R.3954: To suspend temporarily the duty on Disperse Red 311. H.R.3955: To suspend temporarily the duty on Reactive Blue 187. H.R.3956: To suspend temporarily the duty on Disperse Yellow 71. H.R.3957: To suspend temporarily the duty on mixtures of Acid Black 244, (Chromate(2-), (Cobaltate(1-), and (Chromate(1-). H.R.3958: To suspend temporarily the duty on Acid Blue 284. H.R.3959: To suspend temporarily the duty on Basic Blue 94:1. H.R.3960: To suspend temporarily the duty on Disperse Orange 288. H.R.3961: To suspend temporarily the duty on Disperse Blue 284. H.R.3962: To suspend temporarily the duty on Disperse Blue 56. H.R.3963: To suspend temporarily the duty on Acid Blue 264. H.R.3964: To suspend temporarily the duty on mixtures of (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-hydroxyphenyl)-) and (9,10-Anthracenedione, 1,5-diamino-4,8-dihydroxy(4-methoxyphenyl)-). H.R.3965: To suspend temporarily the duty on Acid Red 426. H.R.3966: To suspend temporarily the duty on mixtures of Reactive Blue 250 and Reactive Black 5. H.R.3967: To suspend temporarily the duty on mixtures of Reactive Black 5, Benzenesulfonic acid, and 1-Naphthalenesulfonic acid. H.R.3968: To suspend temporarily the duty on mixtures of Disperse Red 367, Benzo, and Acetic acid. H.R.3969: To suspend temporarily the duty on mixtures of Disperse Blue 77. H.R.3970: To suspend temporarily the duty on mixtures of Reactive Red 198 and Reactive Red 239. H.R.3971: To suspend temporarily the duty on mixtures of Reactive Blue 19. H.R.3972: To suspend temporarily the duty on certain woven fabrics of cotton.
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · first_quarter · Health Issues
Implementation of H.R. 3590, The Patient Protection and Affordable Care Act Sections (P.L. 111-148) Title IIIImproving the Quality and Efficiency of Health Care; Implementation of the American Recovery and Reinvestment Act of 2009,(P.L. 111-5) Title XIII the Health Information Technology for Economic and Clinical Health Act (HITECH Act); H. R. 3239 to provide certain legal safe harbors to Medicare and Medicaid providers who participate in the EHR meaningful use program. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $25,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA), White House Office
2012 · first_quarter · Health Issues
Establish and preserve accountable care organizations in California, preserve funding for certain Medicare Advantage plans; establish medical homes; establish CMS innovation center (H.R. 3962, Sec. 1301, 1302, 1907; Div. B., Title I, Subtitle D; Affordable Health Care for America Act. H.R. 3590, Sec. 3021, 3022, 9010; Part III, Subtitle C, Patient Protection and Affordable Care Act)
Client expense: Not reported · Firm income: $80,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2012 · first_quarter · Health Issues
Supported Association/Small Business Health Plan Legislation. Opposed the Patient Protection and Affordable Care Act (H.R. 3590/H.R. 3962). Urged repeal of requirements in PPACA for businesses to file 1099 tax form for purchases from any vendor exceeding $600 anually. Supported the American Jobs Protection Act (H.R. 1744/S. 20) and other offers to eliminate the employer mandate. Supported H.R. 1370 and additional efforts to repeal health insurance tax.
Client expense: $428,630 · Firm income: Not reported
Government targets: Commerce, Dept of (DOC), HOUSE OF REPRESENTATIVES, Intl Trade Administration (ITA), SENATE, U.S. International Trade Commission (ITC)
2012 · first_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. 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, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. 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. 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. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Conrad State 30 Improvement Act (S. 1979): Supported provisions of this legislation including, eliminating the need for repeated reauthorization of the Conrad 30 program, increasing the number of Conrad 30 J-1 waivers to address the increased demand for such waivers by states, while maintaining a well-balanced national distribution, allowing a 120 day grace period for new employment if a physician is terminated due to extenuating circumstances, and a green card cap exemption, which would provide an important incentive for international medical graduates to practice in underserved communities. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Provided comments to the Department of Health & Human Services regarding the value-based modifier, penalties under the electronic prescribing (e-prescribing) program, physician quality reporting system (PQRS) and electronic health record (EHR) incentive program, along with the transition to ICD-10. The College urged CMS to re-evaluate the penalty timelines associated with these programs and examine the administrative and financial burdens and intersection of these various federal regulatory programs, to use its discretionary authority provided by Congress under these programs to develop solutions for synchronizing these programs to minimize burdens to physician practices, and propose these solutions in the physician fee schedule proposed rule for calendar year 2013.
Client expense: $275,504 · 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
2012 · first_quarter · Health Issues
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 (111th Congress). Support Implementation and Improvement of the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Establishing a new Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Creating a new Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program. 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 a voluntary shared savings program, Accountable Care Organizations, that promotes accountability for services delivered to a defined Medicare fee-for-service (FFS) patient population with the goals of increasing the quality and efficiency of services delivered; 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). Specifically, beginning in April 2011, urged Congress to enact legislation that would provide stable payments for all physician specialties for at least five years while providing higher updates for undervalued evaluation and management services, require that different payment models (including Patient-Centered Medical Homes) be pilot-tested on a voluntary basis during the five year period of stable payments, and designate a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots. 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; Advocated for a proposal released by Rep. Allyson Schwartz (D-PA) in Nov 2011 that would eliminate Medicare's flawed SGR formula and transition to new physician payment models that are aligned with value; Advocated for repealing the SGR and using the Overseas Contingency Operation (OCO) funds to offset the cost. 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, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage. Appropriations for FY 2013: Advocated for the highest level of funding possible for the Labor-HHS-Education bill within the discretionary cap established by the Budget Control Act (BCA); Supported $520 million for Title VII Health Professions and Title VIII Nursing Programs to the House and Senate Labor-HHS-Education Appropriations Subcommittees; Supported $400 million to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for a base, discretionary budget of $400 million in FY 2013 for AHRQ; Advocated for at least $7.0 billion for the Health Resources and Services Administration (HRSA); Specifically, the College supported Title VII, Section 747, Primary Care Training and Enhancement, at no less than $71 million; National Health Service Corps, $535,087,442 million in discretionary funding, in addition to the $300 million in enhanced funding through the Community Health Centers Fund; National Health Care Workforce Commission, $3 million; and Centers for Medicare and Medicaid Services, Operations and Management of Exchanges, $574.5 million. 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. 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. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. 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; 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. National workforce policy to ensure sufficient numbers of primary care and other physicians: Urged support for 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; Fully fund the commission at levels authorized in the Affordable Care Act; 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; Urge enactment of H.R. 5, the HEALTH Act, as initially introduced, which would set national standards for medical malpractice, including a $250,000 cap on non-economic damages. The Conrad State 30 Improvement Act (S. 1979): Supported provisions of this legislation including, eliminating the need for repeated reauthorization of the Conrad 30 program, increasing the number of Conrad 30 J-1 waivers to address the increased demand for such waivers by states, while maintaining a well-balanced national distribution, allowing a 120 day grace period for new employment if a physician is terminated due to extenuating circumstances, and a green card cap exemption, which would provide an important incentive for international medical graduates to practice in underserved communities. The Restoring Access to Medication Act (H.R. 2529): Advocated for this legislation that overturns the restrictions placed on tax-preferred accounts reimbursing for over-the-counter (OTC) medicines without first getting a prescription. This legislation will restore efficiencies in the healthcare system and consumer access to vital, frontline medicines that were disrupted by ACA. The Primary Care Workforce Access and Improvement Act of 2011 (H.R. 3667): Supported this legislation that would authorize the Secretary of Health and Human Services (HHS) to conduct a five year Medicare pilot project that would direct a share of Graduate Medical Education funding to medical education entities to test different models of primary care training. This legislation would give the Secretary of HHS the authority to test new models of care that demonstrate the capability of improving the quality, quantity, and distribution of primary care physicians. Provided comments to the Department of Health & Human Services regarding the value-based modifier, penalties under the electronic prescribing (e-prescribing) program, physician quality reporting system (PQRS) and electronic health record (EHR) incentive program, along with the transition to ICD-10. The College urged CMS to re-evaluate the penalty timelines associated with these programs and examine the administrative and financial burdens and intersection of these various federal regulatory programs, to use its discretionary authority provided by Congress under these programs to develop solutions for synchronizing these programs to minimize burdens to physician practices, and propose these solutions in the physician fee schedule proposed rule for calendar year 2013.
Client expense: $148,500 · 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
2012 · first_quarter · Medicare/Medicaid
The following bullet points summarize the objectives of the Marshfield Clinics Health Policy Agenda: value-based purchasing of health services including bonus payments for high value Medicare Advantage programs; establishment and funding of comparative effectiveness research; new formulas for aligning Medicare reimbursement with value; bonus payments for efficient providers; bonus payments for primary care providers; financing for the adoption and utilization of health information technology; repeal and reform of the Medicare sustainable growth rate mechanism for updating physician payments; improved reimbursement for the CMS Physician Group Practice (PGP) demonstration; expansion of the PGP demonstration methodology into a national accountable care organization program to extend the physician group practice demonstration; Adequate funding for CMS; Adequate funding for community health centers; Funding for after-school programs Integration of Medical and dental care and records Meaningful use of HIT; Funding for medical simulation training Personalized medicine Healthy lifestyles programs Budget Control Act (S. 365, PL 112-25) provisions requiring mandatory sequestration of federal funding if Congress does not act to implement deficit reduction. Medicare Payment Advisory Commission recommendations regarding reform of the Sustainable Growth Rate (SGR) formula of the Medicare physician fee schedule, and offsets to fund the reforms. H.R.3682 : Patient Centered Healthcare Savings Act of 2011 Sponsor: Rep Duffy, Sean P. - Marshfield Clinic, the corporate sponsor of Security Health Plan, a five star Medicare Advantage program, opposes provisions which promote the sale of insurance across state lines but do not address the disparities in existing state law which would allow other insurance entities to circumvent Wisconsin law. HR 3630 the House Payroll Tax holiday bill H.R.3630 Temporary Payroll Tax Cut Continuation Act of 2011 Sponsor: Rep Camp, Dave. The bill also included a "doc fix" - a 1% increase in Medicare physician payment for 2012 and 2013; The bill also extends through 2012 the floor at 1.0 on the work geographic index in the formula for determining relative values for physicians' services for the Medicare physician payment; and directed MEDPAC to assess whether any geographic adjustment is needed under Medicare to distinguish the difference in work effort by geographic area, and if so, what that level should be and were it should be applied. The bill also revises Medicare hospital outpatient department (OPD) payment amounts for evaluation and management services, bringing them into parity with physician E&M payments. H.R.3765 Temporary Payroll Tax Cut Continuation Act of 2011 Sponsor: Rep Camp, Dave two month extension Medicare physician payment increase. Value Based Purchasing The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. Recommendations: Medicare and other payors must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Variations in Health Care Service and Distribution Research conducted the Medicare Payment Advisory commission and the Dartmouth School of Medicine has documented glaring variations in how medical resources are distributed and used in the United States. Medicare pays many hospitals and their doctors much more than what it pays the most efficient and effective health care institutions to treat chronically ill people, yet they still get worse results. The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should lead us to ask if some chronically ill Americans are getting more care than they actually want or need. Caring for people with chronic disease now accounts for more than 75 percent of all health-care spending. Over-use and overspending is not just a Medicare problemthe health-care system as a whole lacks efficient, effective ways of caring for people with severe chronic illnesses. If the U.S. health care system mirrored the practice patterns of the most efficient/effective health care institutions, Medicare and other payors could save billions of dollars annually. Sustainable Growth Rate Medicares SGR mechanism unfairly links physician payment updates to factors unrelated to patients needs and the cost of providing patient care. For years the Marshfield Clinic has watched Medicare physician payments atrophy in proportion to the cost of providing Medicare Services. In 2010 the Clinic recovered only 52.45% of the Medicare Allowable Costs of serving Medicare patients. In 2009 the Clinic lost 49.6 cents on each dollar of care provided. As payments have deteriorated in both the Medicare and Medicaid sector, the Clinic has documented increasing patient counts as other physicians and providers in the communities that we serve turn patients away. The difficulty of correctly updating physician fees is complicated by problems with the fee schedule regarding resource use, compensation for care coordination, and volume growth that point to Mispricing related to the value of physician services; inaccuracy of practice expense (overhead) calculations; and increasing variation in the volumes of services provided in different regions of the country. Uncertainty about the Medicare/Medicaid revenue stream complicates Clinic efforts to provide services where they are needed. Stability, adequacy, and predictability in payment should be the highest priority for Congress to assure high quality efficient care for all patients, but especially for the 20% of the population that is chronically ill and responsible for 75% of Medicare spending. Medicare Payment Inequities In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. The Update formula for physician services is inequitable because it treats all physicians and regions of the country alike regardless of their individual volume influencing behavior. If the problem of cost is related to the volume of services provided, shouldnt payment be volume adjusted for specific localities? Why should conservative practices and States be punished for the excessive volume of other localities? Payment Equity for Physician Work There is no difference in the work of physicians in different locations regardless of where the work occurs. We believe that physician work should not be adjusted for geographic location. What is the rational for paying physicians more in many geographic areas when those same areas have apparently ample numbers of physicians and their wages are trending below physician wages in other areas? Should the Medicare program subsidize physicians who chose to live in high cost areas? Recommendation: the geographic adjustment of physician work should be eliminated entirely on a Budget neutral basis. Payment Fairness for Practice Costs The formulas by which Medicares payments are calculated are widely variable throughout Medicare localities, and are based upon outdated data assumptions regarding the cost and organization of medical practice. Medicares physician fee schedule, which specifies the amount that Medicare will pay for each physician service, includes adjustments that are ostensibly made to ensure that the fees paid reflect systematic and enduring variation in geographic practice-related costs. Currently, CMS uses the median hourly earnings of four occupational classes -- Clerical Workers, Registered Nurses, Licensed Practical Nurses, and Medical Technicians -- found in physician offices as proxy non-physician wage input cost measures. These proxy occupational classes, which were the most common employees in physician practices in the 1980s, are now only a subset of non-physician employees in physician practices. The practice of medicine has changed substantially since the proxy measurement formulae were established. Recommendation: Congress should require CMS to administratively revise its measurement of cost of practice to assure the validity and fairness of payments. Medicare Advantage The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. Corresponding mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. Performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Accountable Care Organizations One important delivery system reform is the Medicare Shared Savings Program under section 3022 of the Affordable Care Act, which promotes the formation and operation of accountable care organizations (ACOs). Under this provision, groups of providers meeting the criteria specified by the Secretary may work together to manage and coordinate care for Medicare beneficiaries through an [ACO]. An ACO may receive payments for shared savings if the ACO meets certain quality performance standards and cost savings requirements established by the Secretary. The basic shared savings model outlined in the statute provides a bonus payment to ACOs that meet quality targets and keep spending for the population for whom the ACO is responsible below a target level. The amount of the bonus payment will depend on the amount of savings and the proportion of the savings allocated to the ACO and Medicare ACOs should report a focused set of quality indicators that reflect the outcomes ACOs are designed to achieve: keeping the population healthy, better care coordination to reduce unnecessary and sometimes harmful spending, and better patient experience. New measures may be necessary for ACOs because the current measures reflect the limitations and incentives of the current FFS payment system. A focused set of measures would help assure Medicare that the ACO is doing its job and help assure beneficiaries that they are receiving high quality care. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. The federal government developed formulae to evaluate the cost of providing services in different practice settings and in different geographic locations. Those formulae measure resource inputs that have changed over the +40 year life of the program. To ensure affordable access to Medicare services throughout the country Medicare must take steps to refine its measures of the cost of providing services so that Medicares overwhelming financial dominance does not interfere with affordable access in markets that have changed very much since the program began. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs. Community Health Centers Under Health Reform The Affordable Care Act included provisions relating to community health centers, including $11 billion in new funding for the community health center program over the next five years and $1.5 billion over the next five years to expand the National Health Service Corp. While these are mandatory funding levels, it is possible that the Congress might cut the base funding levels for community health centers and the National Health Service Corp effectively diminishing the impact of the reform legislation. As reform is rolled out there are key payment protections and improvements for community health centers. For example, the Act requires that health centers receive no less than their Medicaid rate from private insurers offering plans through the new health insurance exchanges and it requires that these plans must contract with health centers. Other provisions add preventive services to the federally qualified health center Medicare payment rate and eliminates the outdated Medicare payment cap on FQHC payments. This will begin to modernize the health center Medicare payments to insure health centers are able to provide highest quality care to Medicare beneficiaries. Historically, Family Health Center and Marshfield Clinic have not attempted to access cost-based reimbursement under Medicare because of these payment caps. Dental Access and Integration with Traditional Medicine The Institute of Medicine (IOM) released a report, Dental Education at the Crossroads: Challenges and Change in January 1995 which called for a strong cohesion between medicine and dentistry. The IOM report states that "Dentistry will and should become more closely integrated with medicine and the health care system on all levels: research, education, and patient care." The National Institutes of Health has supported research documenting the importance of oral health in the context of general health and well being. Studies have demonstrated numerous oral-systemic interactions that underscore the need for more integrated care delivery. As our nation embraces EHR technologies, science underscores the need to fully incorporate oral health within an integrated EHR. Marshfield Clinic is simultaneously addressing the issue of dental access and integration with traditional medicine. Family Health Center of Marshfield, Inc. (FHC) in partnership with Marshfield Clinic has been serving low-income, underinsured and uninsured individuals since March 1974. Using technology to integrate medical and dental health records holds great promise to improve the quality, safety, efficiency, effectiveness and continuity of patient care by enhancing communication and teamwork between physicians and dentists. A comprehensive approach to primary care delivery, demonstrated by Marshfield Clinic and community health centers nationwide, can best be supported with an equally comprehensive EHR infrastructure for both medical and dental records. Meaningful Use of Health Information Technology The accelerating growth in new medical knowledge, coupled with the birth of new sciences, such as genomics and personalized medicine, suggests that physicians, nurses, and other healthcare professionals will invariably continue to fall further and further behind in their ability to keep up with the latest discoveries and approved treatments. As information technology has sparked this explosive growth in knowledge, only information technology can provide an adequate response. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare. Health IT on a broad basis is still in its infancy. Looking to what can be achieved in the future due to implementation of these systems should be our focus, and an ongoing oversight function of the Office of the National Coordinator for HIT which must be closely integrated with Medicare reimbursement. Personalized Medicine Personalized medicine is the concept that envisions an individually tailored approach to detecting, preventing, and treating disease based on a person's specific genetic profile. If the multiple population groups in the United States and elsewhere in the world are to benefit fully and fairly from such research, a national resource operated as a trust for the public good must be established to conduct a large population-based cohort study that includes full representation of minority populations. Marshfield Clinic has developed a comprehensive bio-bank, consisting of DNA samples from 20,000+ individuals. The samples, often from extended families, have been linked electronically to medical records for more than 20 years of medical history. Further development of this public health infrastructure is in the national interest. The Federal government should make critical investments in the enabling tools and resources essential to moving beyond genomic discoveries to personalized medicine services of patient and public benefit. Medical Simulation Training The Accreditation Council on Graduate Medical Education (ACGME) Program Requirements for Resident Education in Internal Medicine has recommended that residency programs need to "Provide residents with access to training using simulation". The need for medical simulation is great; medical errors continue to kill approximately 98,000 people annually. Over the past decade, this amounts to almost a staggering one million accidental patient deaths. These errors cost the US approximately $17-$29 billion annually. Medical errors are highly preventable through the use of modeling and simulation in medical education. Simulation will enhance technical and communication skills of physicians and other medical providers in high fatality, low frequency skills, such as emergency cricothyroidotomy, and amniocentesis and physician re-entry skill verification, such as pelvic exam and central line placement. Simulation experiences also provide the opportunity to enhance team communication and patient to provider communication through the recreation of uncommon or stressful scenarios such as obtaining a sexual health history or abuse/neglect screening. Marshfield Clinic will support legislation to initiate, maintain and grow medical simulation programs through the identification of simulation centers of excellence, advancement of simulation technologies, allocation of grant funds for institutions who train healthcare providers and call together key leaders to discuss the direction of medical simulation Medicaid Block Grants On March 29, the House approved Rep. Paul Ryans budget proposal for FY 2013, entitled "The Path to Prosperity. Ryan's proposal does not have the force of law but of special interest is Ryans proposal for Medicaid block grants which will come before the Energy and Commerce Committee. Under the Ryan proposal, starting in 2013, the federal share of all Medicaid payments would be paid to the states as a block grant. Chairman Ryan has projected savings to federal government that would result from reduced funding to states. Premium support On March 29, the House approved Rep. Paul Ryans budget proposal for FY 2013, entitled "The Path to Prosperity. Ryan's budget does not have the force of law but tees up consideration of various reform proposals which may be considered later this year. With regard to health care, the Ryan plan calls for a major withdrawal of the federal government from the financing of health care. One health provision of the proposal calls for conversion of the current Medicare to a premium support program. For people now 55 or younger, the traditional Medicare program a defined benefit plan would cease to exist and, starting in 2023, would be converted to a defined contribution program which has been described as a premium support program. Practice expense geographic practice cost index (GPCI) adjustment: Retroactively effective from Jan. 1, 2010, HHS is required to revise the calculation method of the practice expense (PE) portion of the GPCI. This revision results in increased PE GPCIs for certain rural areas Statutory provisions to extend these additional payments lapse in 2012 and must be extended for 2013. CMS Physician Group Practice Demonstration On September 27, 2002 the Centers for Medicare and Medicaid Services initially published a notice in the Federal Register informing interested parties of an opportunity to submit proposals for participation in the Medicare Physician Group Practice Demonstration (PGP) project to test a hybrid payment methodology that combines Medicare fee-for-service payments with a bonus pool derived from savings achieved by improvements in patient care management. Marshfield Clinic was selected by CMS to participate in the demonstration program, effective April 1, 2005 and has been involved as a participant working with CMS ever since. Marshfield Clinic supports CMS determination to extend this program, and transition these organizations into Accountable care Organizations. Section 1301 of the House bill HR 3962, the Affordable Health Care for America Act, and Section 3022 of the Senate bill HR 3590, the Patient Protections and Affordable Care Act.
Client expense: $130,000 · 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
2012 · first_quarter · Food Industry (safety, labeling, etc.)
Monitor issues pertaining to the Dietary Supplement Health and Education Act (DSHEA). Affordable Health Care for America (H.R. 3962). Patient Protection and Affordable Care Act (PL 111-148). Monitor and explain impacts of NDI guidance issued by the FDA.
Client expense: Not reported · Firm income: $20,000
Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE
2012 · first_quarter · Health Issues
Health Insurance Individual Market H.R. 3962: Affordable Health Care for America Act H.R. 3200: America's Affordable Healthcare Choices Act Health Care Reform Medical Loss Ratio legislation H.R. 3590: Patient Protection & Affordable Care Act
Client expense: Not reported · Firm income: $10,000
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2011 · third_quarter · Health Issues
H.R. 1021/S.1548- Access to Americas Orthopedic Service Act of 2009: Musculoskeletal Disease and Condition Legislation to improve research, diagnosis, and treatment of musculoskeletal disease, conditions, and injuries, to conduct a longitudinal study on aging, and for other purposesH.R. 3693- Ensuring the Future Physician Workforce Act of 2009 H.R. 4851-Continuing Extension Act 2010 H.J. RES 45- Increasing the statutory limit on the public debt H.R. 3962- Affordable Health Care for American 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-Americas Affordable Health Choices Act of 2009: provide affordable, quality health care for all American and reduce the growth in health care spending, and for other purposes. H.R. 1678- Mitigation 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) authorize the Secretary of Health and Human Services (HHS) to develop and implant a National Bone Health Program for the control, Prevention, and surveillance of osteoporosis and related bone diseases and to coordinate and carry out nation education and outreach activities in support of such program: (2) authorize the Secretary to award grants to state and Indian tribes for comprehensive osteoporosis and related bone disease control and prevention programs: and (3) award grants or enter into cooperative agreement for the collection, analysis, and reporting of data on osteoporosis and related bone diseases, including ontogenesis imperfect and Pagets disease of the bone. Surgical Workforce Shortage Truth and Transparency
Client expense: $286,383 · Firm income: Not reported
Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE
2011 · third_quarter · Medical/Disease Research/Clinical Labs
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 Physician Workforce Act of 2009 H.R. 4851-Continuing Extension Act 2010H.J. RES 45- Increasing the statutory limit on the public debt H.R. 3962- Affordable Health Care for American Act H.R. 3962-The Presevation 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-Partient 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 StarkII- Physician Ban on Self-referral and Other Fraud & Abuse: ensure the Stark laws do not prevent timely access to quality medical services. Surgical Workforce Shortage
Client expense: $286,383 · Firm income: Not reported
Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, SENATE
2011 · third_quarter · Health Issues
Coverage of A1c diabetes test H.R. 3962 (the Affordable Health Care for America Act); advocacy efforts in Congress relating to provisions included in H.R. 4213 (the Tax Extenders Act of 2009, among the other short titles) that would amend the drug-discount program under section 340B of the Public Health Services Act
Client expense: Not reported · Firm income: $100,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2011 · first_quarter · Medicare/Medicaid
Healthcare reform; healthcare regulations; Medicare part D; proposed antitrust exemptions for certain pharmacies; IVIG payments; Medicare demonstration projects for durable medical equipment; importation of prescription drugs; home infusion; disclosure of PBM information; changes to drug benefits offered under the FEHBP and increasing healthcare value; competitive bidding. HR 574 and S 254 - Medicare Home Infusion Coverage Act; all sections HR 1765 - To Amedn Title XVIII of the SSA with respect to payment for the furnishing of intravenous immune globulin (IVIG) in a patient's home for the treatment of primary immune deficiency diseases and to cover certain disposable pumps as durable medical equipment in place of non-disposable pumps under the Medicare program; all sections HR 3962 - Affordable Care Act for All America Act; all sections S 1796 - America's Health Future Act; sections 1001-2221 HR 3790 - To amend Title XVIII of the SSA to repeal the Medicare Competitive Acqusition program for durable medical equipment and prosthetics, orthotics and supplies (DMEPOS); all sections Public Law 111-152 - Health Care and Education Reconciliation Act (formerly HR 4872); all sections HR 1041 - Fairness in Medciare Bidding Act (FIMBA), section 2
Client expense: $1,080,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Personnel Management (OPM), Postal Rate Commission, Postal Regulatory Commission, SENATE, U.S. Postal Service (USPS)
2011 · first_quarter · Health Issues
H.R. 4872 - The Reconcilliation Act of 2010 H.R. 3590 - The Patient Protection and Affordable Health Care Act H.R. 3962 - The Affordable Health Care for America Act Repeal of 1099 Form Regulations within H.R. 3590 (H.R. 4/S. 18/S. 72)
Client expense: $196,000 · Firm income: Not reported
Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR)
2011 · first_quarter · Small Business
H.R. 1259 - Estate Tax: Bill to permanently repeal the estate tax H.R. 4, S. 72, S. 18 -- Repeal of expanded 1099 legislation H.R. 3962 - The Affordable Health Care For America Act
Client expense: $196,000 · Firm income: Not reported
Government targets: Agriculture, Dept of (USDA), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Interior, Dept of (DOI), Internal Revenue Service (IRS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR)
2011 · fourth_quarter · Health Issues
S 301 - Physician Payments Sunshine Act of 2009 HR 1191/S 1336 - Safe Drug Disposal Act of 2009 HR 1260/S 515 & 610 - Patent Reform Act of 2009 HR 1298/S 525 - Pharmaceutical Market Access and Drug Safety Act of 2009 HR 1359/S 1292 - Secure and Responsible Drug Disposal Act of 2009 HR 1427/S 726 - Promoting Innovation and Access to Life-Saving Medicine Act HR 1548 - Pathway for Biosimilars Act HR 1706/S 369 - Protecting Consumer Access to Generic Drugs Act of 2009/Preserve Access to Affordable Generics Act of 2009 HR 3200/S 1796 - America's Affordable Health Choices Act of 2009 / America's Healthy Future Act of 2009 HR 3590 - Patient Protection and Affordable Care Act HR 3962 - Affordable Health Care for America Act HR 4872 - Health Care and Education Reconciliation Act of 2010 HR 4956 - Stop Oxy Abuse Act of 2010 HR 756 - National Pain Care Policy Act of 2009 HR 5712 - Veterans', Seniors', and Children's Health Technical Corrections Act of 2010 HR 5809/S 3397 - Safe Drug Disposal/Secure and Responsible Drug Disposal Act of 2010 HR 6165/S 4018 - Life Sciences Jobs and Investment Act of 2010 Anti- counterfeiting legislation concerning drugs (pedigree) Biosimilar Drugs Disposal of Drugs Drug Reimportation Healthcare Reform Hearings related to prescription drug abuse and prevention Life sciences research tax credit legislation Patent Settlements Pedigree Legislation Prescription Drug User Fee Act reauthorization RiskEvaluation and MitigationStrategies for controlled substances Tax on pharmaceutical companies (Senate Finance Committee draft of health care reform)
Client expense: $120,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2011 · fourth_quarter · Medicare/Medicaid
S 301 - Physician Payments Sunshine Act of 2009 HR 1191/S 1336 - Safe Drug Disposal Act of 2009 HR 1260/S 515 & 610 - Patent Reform Act of 2009 HR 1298/S 525 - Pharmaceutical Market Access and Drug Safety Act of 2009 HR 1359/S 1292 - Secure and Responsible Drug Disposal Act of 2009 HR 1427/S 726 - Promoting Innovation and Access to Life-Saving Medicine Act HR 1548 - Pathway for Biosimilars Act HR 1706/S 369 - Protecting Consumer Access to Generic Drugs Act of 2009/Preserve Access to Affordable Generics Act of 2009 HR 3200/S 1796 - America's Affordable Health Choices Act of 2009 / America's Healthy Future Act of 2009 HR 3590 - Patient Protection and Affordable Care Act HR 3962 - Affordable Health Care for America Act HR 4872 - Health Care and Education Reconciliation Act of 2010 HR 4956 - Stop Oxy Abuse Act of 2010 HR 756 - National Pain Care Policy Act of 2009 HR 5712 - Veterans', Seniors', and Children's Health Technical Corrections Act of 2010 HR 5809/S 3397 - Safe Drug Disposal/Secure and Responsible Drug Disposal Act of 2010 HR 6165/S 4018 - Life Sciences Jobs and Investment Act of 2010 Anti- counterfeiting legislation concerning drugs (pedigree) Biosimilar Drugs Disposal of Drugs Drug Reimportation Healthcare Reform Hearings related to prescription drug abuse and prevention Life sciences research tax credit legislation Patent Settlements Pedigree Legislation Prescription Drug User Fee Act reauthorization RiskEvaluation and MitigationStrategies for controlled substances Tax on pharmaceutical companies (Senate Finance Committee draft of health care reform)
Client expense: $120,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2011 · fourth_quarter · Copyright/Patent/Trademark
S 301 - Physician Payments Sunshine Act of 2009 HR 1191/S 1336 - Safe Drug Disposal Act of 2009 HR 1260/S 515 & 610 - Patent Reform Act of 2009 HR 1298/S 525 - Pharmaceutical Market Access and Drug Safety Act of 2009 HR 1359/S 1292 - Secure and Responsible Drug Disposal Act of 2009 HR 1427/S 726 - Promoting Innovation and Access to Life-Saving Medicine Act HR 1548 - Pathway for Biosimilars Act HR 1706/S 369 - Protecting Consumer Access to Generic Drugs Act of 2009/Preserve Access to Affordable Generics Act of 2009 HR 3200/S 1796 - America's Affordable Health Choices Act of 2009 / America's Healthy Future Act of 2009 HR 3590 - Patient Protection and Affordable Care Act HR 3962 - Affordable Health Care for America Act HR 4872 - Health Care and Education Reconciliation Act of 2010 HR 4956 - Stop Oxy Abuse Act of 2010 HR 756 - National Pain Care Policy Act of 2009 HR 5712 - Veterans', Seniors', and Children's Health Technical Corrections Act of 2010 HR 5809/S 3397 - Safe Drug Disposal/Secure and Responsible Drug Disposal Act of 2010 HR 6165/S 4018 - Life Sciences Jobs and Investment Act of 2010 Anti- counterfeiting legislation concerning drugs (pedigree) Biosimilar Drugs Disposal of Drugs Drug Reimportation Healthcare Reform Hearings related to prescription drug abuse and prevention Life sciences research tax credit legislation Patent Settlements Pedigree Legislation Prescription Drug User Fee Act reauthorization RiskEvaluation and MitigationStrategies for controlled substances Tax on pharmaceutical companies (Senate Finance Committee draft of health care reform)
Client expense: $120,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2011 · fourth_quarter · Alcohol and Drug Abuse
S 301 - Physician Payments Sunshine Act of 2009 HR 1191/S 1336 - Safe Drug Disposal Act of 2009 HR 1260/S 515 & 610 - Patent Reform Act of 2009 HR 1298/S 525 - Pharmaceutical Market Access and Drug Safety Act of 2009 HR 1359/S 1292 - Secure and Responsible Drug Disposal Act of 2009 HR 1427/S 726 - Promoting Innovation and Access to Life-Saving Medicine Act HR 1548 - Pathway for Biosimilars Act HR 1706/S 369 - Protecting Consumer Access to Generic Drugs Act of 2009/Preserve Access to Affordable Generics Act of 2009 HR 3200/S 1796 - America's Affordable Health Choices Act of 2009 / America's Healthy Future Act of 2009 HR 3590 - Patient Protection and Affordable Care Act HR 3962 - Affordable Health Care for America Act HR 4872 - Health Care and Education Reconciliation Act of 2010 HR 4956 - Stop Oxy Abuse Act of 2010 HR 756 - National Pain Care Policy Act of 2009 HR 5712 - Veterans', Seniors', and Children's Health Technical Corrections Act of 2010 HR 5809/S 3397 - Safe Drug Disposal/Secure and Responsible Drug Disposal Act of 2010 HR 6165/S 4018 - Life Sciences Jobs and Investment Act of 2010 Anti- counterfeiting legislation concerning drugs (pedigree) Biosimilar Drugs Disposal of Drugs Drug Reimportation Healthcare Reform Hearings related to prescription drug abuse and prevention Life sciences research tax credit legislation Patent Settlements Pedigree Legislation Prescription Drug User Fee Act reauthorization RiskEvaluation and MitigationStrategies for controlled substances Tax on pharmaceutical companies (Senate Finance Committee draft of health care reform)
Client expense: $120,000 · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
2011 · fourth_quarter · Health Issues
Protect Life Act, H.R. 358 Protect Life Act, S Title X Abortion Provider Prohibition Act, H.R. 217 No Taxpayer Funding for Abortion Act, H.R.3 Foxx Amendment on abortion funding and conscience protection in qualified teaching health centers, to H.R. 1216 H. Con Res 34, Establishing the budget for the United States Government for fiscal year 2012 and setting forth appropriate budgetary levels for fiscal years 2013 through 2021 Opposition to the Medicare Physicians Fairness Act called the Doc Fix bill Opposition to Democrat Health Care bill, H.R. 3962, in the House and the Senate Support for preventing tax dollars from being used for abortions in Democrat Health Care bill, H.R. 3962. Support for Congressman Pete Sessions resolution, H.Res.874, which would require that all roll-call votes in House committees be posted on their respective websites within 48 hours of each vote Support for Senator Orrin Hatchs amendments to restore abstinence funding ($50 million) in the Senate Financial Services Committees debate on their health care reform bill; and to prevent federal tax dollars from being used to fund abortions; and to protect the conscience rights of health care workers not to be forced to do abortions Congressman Doug Lanborns Schoolchildrens Health Protection Act, H.R. 2458 Support for Genetic Discrimination Ban Opposition to the expansion of the Childrens Health Insurance Program (SCHIP) H.R. 322, Alternative Pluripotent Stem Cell Act S. 51, Pluripotent Stem Cell Therapy Enhancement Act Opposition to H.R.3 and S.5, the Embryonic Stem Cell Destruction bill H.R.2564, Human Cloning Prohibition Act and opposed the phony ban (H.R. 2560) S.1036, Human Cloning Prohibition Act OPPOSITION to H.R. 1964 and S. 1173, Freedom of Choice Act H.R.618, Right to Life Act H.R.2597, Sanctity of Life Act H. J. Res. 20, Opposition to language in Continuing (Omnibus) Appropriations Bill, which would cut funding (Section 20613 [b]) for the early diagnosis of babies with AIDS. Opposition to legislation deleting $50 million in abstinence funding
Client expense: Not reported · Firm income: Not reported
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2011 · fourth_quarter · Medicare/Medicaid
H.R. 3962 Affordable Health Care For America Act; S.1796 Americas Healthy Future Act Of 2009; H.R. 3200 America's Affordable Health Choices Act of 2009. For all of the above, provisions relating to Medicare Special Needs Plans, especially risk adjustment, quality measurement, and compliance/oversight. Legislative and administrative rules and regulations related to Medicare Advantage and Special Needs Plans.
Client expense: $290,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE
2011 · fourth_quarter · Health Issues
Implementation of H.R. 3590, The Patient Protection and Affordable Care Act Sections (P.L. 111-148) Title IIIImproving the Quality and Efficiency of Health Care; Implementation of the American Recovery and Reinvestment Act of 2009,(P.L. 111-5) Title XIII the Health Information Technology for Economic and Clinical Health Act (HITECH Act); H. R. 3239 to provide certain legal safe harbors to Medicare and Medicaid providers who participate in the EHR meaningful use program. H.R.3962 - Affordable Health Care for America Act - Provisions relating to Health Information Technology H.R.3590 - Patient Protection and Affordable Care Act- Provisions relating to Health Information Technology
Client expense: Not reported · Firm income: $25,000
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Transportation Security Administration (TSA), White House Office