To suspend temporarily the duty on certain non-toric shaped polarized materials of 80 mm or less in diameter.

Medical device tax; IC-DISC; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148); Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). H.R. 436 Protect Medical Innovation of 2011, FY2013 Budget, implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

NIH Alzheimer's and health technology research; Community Health Centers and School Health; Telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); The Protect Medical Innovation Act (H.R. 436); Budget Control Act (P.L. 112-25), FY2013 Budget, accountable care organizations ; implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Medical device tax; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148)and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). Protect Medical Innovation of 2011 (H.R. 436), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Health Information Technology Issues; Rural telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148)and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

H.R. 3590 and H.R. 4872, the Affordable Care Act; Health Insurance Regulations, Health Savings Accounts, Essential Health Benefits Indiana Medicaid State Plan Amendment 11-011, waiver request for the Healthy Indiana Plan

Client expense: Not reported · Firm income: $52,000

Government targets: Army, Dept of (Corps of Engineers), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Highway Traffic Safety Administration (NHTSA), SENATE, Transportation, Dept of (DOT)

H.R. 3590 and H.R. 4872, the Affordable Care Act; Health Insurance Regulations, Health Savings Accounts, Essential Health Benefits Indiana Medicaid State Plan Amendment 11-011, waiver request for the Healthy Indiana Plan

Client expense: Not reported · Firm income: $11,000

Government targets: Army, Dept of (Corps of Engineers), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Highway Traffic Safety Administration (NHTSA), SENATE, Transportation, Dept of (DOT)

President's Budget, FY2013, Medicare and Medicaid hospital reimbursement issues. Health care reform, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. H.R.4872, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. H.R.3630, Temporary Payroll Tax Cut Continuation Act of 2011, Temporary extension of health related provisions. Sequestration and fiscal cliff issues, generally.

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medical device tax; IC-DISC; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148); Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). H.R. 436 Protect Medical Innovation of 2011, FY2013 Budget, implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Medical device tax; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148)and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). Protect Medical Innovation of 2011 (H.R. 436), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

NIH Alzheimer's and health technology research; Community Health Centers and School Health; Telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); The Protect Medical Innovation Act (H.R. 436); Budget Control Act (P.L. 112-25), FY2013 Budget, accountable care organizations ; implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Health Information Technology Issues; Rural telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148)and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

HIT funding; Community health center and school health funding; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); Budget Control Act (P.L. 112-25), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Monitor and track issues and legislation affecting Community Health Centers and youth service centers. Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Act & H.R. 4872, The Reconciliation Act. Regulations implementing HIT, ACOs.

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

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

-Patient Protection and Affordable Care Act (H.R. 4872, H. Res. 1203, H. Res. 1225, H.R. 3590) and the American Job Protection Act (S. 20, H.R. 1744) regarding an employers' obligation to provide health care to all full-time employees -Regarding a "profit per employee" metric with which to re-define a small business

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (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

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: $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

PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; HR 1721: Community Living Assistance Services and Supports Act; HR 1670/S 683: Community Choice Act; HR 3043: Medicare Adult Day Services Act of 2009; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; S 582: Social Security Protection Act; PL 79-271: Social Security Act of 1935; HR 1173: The Fiscal Responsibility & Retirement Security Act of 2011; HR 6061: The WIPA (Work Incentives Planning and Assistance) and PABSS (Protection and Advocacy for Beneficiaries of Social Security) Continuation of Services Act of 2012; and HR 6079: Repeal of Obamacare Act.

Client expense: $66,891 · Firm income: Not reported

Government targets: Access Board, Agriculture, Dept of (USDA), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

Medical device tax; IC-DISC; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148); Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). H.R. 436 Protect Medical Innovation of 2011, FY2013 Budget, implementation of S. 3187, the Food and Drug Administration Safety and Innovation Act.

Client expense: $89,168 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Health Information Technology Issues; Rural telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148) and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152), FY2013 Budget.

Client expense: $89,168 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Medical device tax; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148) and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). Protect Medical Innovation of 2011 (H.R. 436), FY2013 Budget.

Client expense: $89,168 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

HIT funding; Community health center and school health funding; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); Budget Control Act (P.L. 112-25), FY2013 Budget.

Client expense: $89,168 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

NIH Alzheimer's and health technology research; Community Health Centers and School Health; Telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); The Protect Medical Innovation Act (H.R. 436); Budget Control Act (P.L. 112-25), FY2013 Budget, accountable care organizations; implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

Client expense: $89,168 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

H.R. 3590 - Patient Protection and Affordable Care Act (implementation) H.R. 4872 - Health Care and Education Reconciliation Act (implementation)

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

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

H.R. 3590 - Patient Protection and Affordability Act (Implementation) H.R. 4872 - Health Care Education Reconciliation Act (Implementation)

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

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

H.R. 3590 and H.R. 4872, the Affordable Care Act; Health Insurance Regulations, Health Savings Accounts, Essential Health Benefits

Client expense: Not reported · Firm income: $52,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

H.R. 3590 and H.R. 4872, the Affordable Care Act, Medicaid expansion Indiana Medicaid State Plan Amendment 11-011, waiver request for the Healthy Indiana Plan

Client expense: Not reported · Firm income: $52,000

Government targets: Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE

H.R. 3590 and H.R. 4872, the Affordable Care Act, Medicaid expansion Indiana Medicaid State Plan Amendment 11-011, waiver request for the Healthy Indiana Plan

Client expense: Not reported · Firm income: $11,000

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

H.R. 3590 and H.R. 4872, the Affordable Care Act; Health Insurance Regulations, Health Savings Accounts, Essential Health Benefits

Client expense: Not reported · Firm income: $11,000

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

PL 108-173: Medicare Prescription Drug and Modernization Act of 2003; HR 1721: Community Living Assistance Services and Supports Act; HR 1670/S 683: Community Choice Act; HR 3043: Medicare Adult Day Services Act of 2009; PL 111-148: The Patient Protection and Affordable Care Act; PL 111-152: Affordable Health Care for America Act; HR 4872: Health Care and Education Reconciliation Act of 2010; S 582: Social Security Protection Act; PL 79-271: Social Security Act of 1935; HR 1173: The Fiscal Responsibility & Retirement Security Act of 2011; HR 6061: The WIPA (Work Incentives Planning and Assistance) and PABSS (Protection and Advocacy for Beneficiaries of Social Security) Continuation of Services Act of 2012; and HR 6079: Repeal of Obamacare Act.

Client expense: $74,200 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Education, Dept of, Energy, Dept of, Equal Employment Opportunity Commission (EEOC), Federal Communications Commission (FCC), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Council on Disability, SENATE, Transportation, Dept of (DOT), U.S. Architectural & Transportation Barriers Compliance Board (ACCESS), Veterans Affairs, Dept of (VA), White House Office

President's Budget, FY2013, Medicare and Medicaid hospital reimbursement issues. Health care reform, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. H.R.4872, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. H.R.3630, Temporary Payroll Tax Cut Continuation Act of 2011, Temporary extension of health related provisions.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HIT funding; Community health center and school health funding; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); Budget Control Act (P.L. 112-25), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Medical device tax; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148)and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). Protect Medical Innovation of 2011 (H.R. 436), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

NIH Alzheimer's and health technology research; Community Health Centers and School Health; Telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); The Protect Medical Innovation Act (H.R. 436); Budget Control Act (P.L. 112-25), FY2013 Budget, accountable care organizations ; implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Medical device tax; IC-DISC; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148); Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152). H.R. 436 Protect Medical Innovation of 2011, FY2013 Budget, implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Health Information Technology Issues; Rural telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148)and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No. 111-152), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Monitor and track issues and legislation affecting Community Health Centers and youth service centers. Regulations stemming from enactment of H.R. 3590, The Patient Protection and Affordable Act & H.R. 4872, The Reconciliation Act. Regulations implementing HIT, ACOs.

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

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

-Patient Protection and Affordable Care Act (H.R. 4872, H. Res. 1203, H. Res. 1225, H.R. 3590) and the American Job Protection Act (S. 20, H.R. 1744) regarding an employers' obligation to provide health care to all full-time employees -Regarding a "profit per employee" metric with which to define a small business

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; designate primary care as a shortage profession; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (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

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

H.R. 3590 - Patient Protection and Affordable Care Act (implementation) H.R. 4872 - Health Care and Education Reconciliation Act (implementation)

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

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

H.R. 3590 - Patient Protection and Affordability Act (Implementation) H.R. 4872 - Health Care Education Reconciliation Act (Implementation)

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

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

NIH Alzheimer's and health technology research; Community Health Centers and School Health; Telemedicine; Implementation of Patent Protection & Affordable Care Act (H.R. 3590/P.L. 111-148) and Health Care and Education Reconciliation Act (H.R. 4872/P.L. 111-152); The Protect Medical Innovation Act (H.R. 436); Budget Control Act (P.L. 112-25), FY2013 Budget, accountable care organizations; implementation of S.3187, the Food and Drug Administration Safety and Innovation Act.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Health Information Technology Issues; Rural telemedicine; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148) and Health Care and Education Reconciliation Act (H.R. 4872/Publ.L.No. 111-152), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE

Medical device tax; Implementation of Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148) and Health Care and Education Reconciliation Act (H.R. 4872/Pub.L.No.111-152). Protect Medical Innovation Act of 2011 (H.R. 436), FY2013 Budget.

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

Government targets: HOUSE OF REPRESENTATIVES, Natl Guard, SENATE