Medicare Physician Payment Innovation Act of 2012

Repeal Sustainable Growth Rate formula; Monitor implementation of P.L. 111-148; Extension of Section 3111, P.L. 111-148; H.R. 5707 Medicare Physician Payment Innovation Act; H.R. 2020 / S. 1096 Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act; H.R. 1700 / S. 1042 Medicare Patient Empowerment Act; H.R. 3613 Part D Beneficiary Appeals Fairness Act

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

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

Reform of Medicare physician fee schedule and formula [Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765); Middle Class Tax Relief and Job Creation Act of 2011 (H.R. 3630); Medicare Physician Payment Innovations Act of 2012 (H.R. 5707)]; Issues pertaining to medical home

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

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

Permanent repeal or patch of the Medicare SGR prior to any cut taking effect; Payment reform to more accurately value cognitive care services; Support HR 5707, Medicare Physician Payment Innovation Act of 2012; Support repeal of the PPACAs Independent Payment Advisory Board; Support HR. 3269 / S. 2347 to eliminate the multiple procedure payment reduction (MPPR) on professional components for select advanced diagnostic imaging services; Opposing automatic sequestration cuts to Medicare Provider Payments; Supporting the inclusion of various cognitive specialties in the 2013 Medicaid provider payments at Medicaid rates; Advocated for better reimbursement for nerve conduction and EMG services and intra-operative neurophysiology monitoring; Advocated to change global period 64615 to 0 day; Opposed expansion of the RAC program to include audits of E/M codes in physician offices; Commented on aspects of the essential health benefits proposal; requesting that neurodevelopmental disorders and dementias be excluded from the umbrella of mental health and included separately.

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

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

Long Term Acute Care Hospitals, Issues pertaining to innovation at the Center for Medicare and Medicaid Services (CMS). Medicare and Medicaid Reimbursement, Issues pertaining to Disproportionate Share Hospital payments and possible reductions to provider payments. H.R. 5707, Medicare Physician Payment Innovation Act of 2012, Issues pertaining to the SGR and changes to health delivery. H.R.6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act, Issues pertaining to reimbursement for graduate medical education, and disproportionate share hospital payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

See page three for specific Medicare/Medicaid issues. H.R. 1409 - Quality Health Care Coalition Act of 2011 H.R. 157 - Health Care Safety Net Enhancement Act of 2011 H.R. 2104 - Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011 H.R. 2119 - Ryan Creedon Act of 2011 H.R. 2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R. 2600 - National Pediatric Acquired Brain Injury Plan Act of 2011 H.R. 3239 - Safeguarding Access For Every Medicare Patient Act H.R. 3474 - PRIME Act of 2011 H.R. 3586 - Good Samaritan Health Professionals Act of 2011 H.R. 4310 - National Defense Authorization Act for Fiscal Year 2013 H.R. 451 - Healthcare Truth and Transparency Act of 2011 H.R. 452 - Medicare Decisions Accountability Act of 2011 H.R. 5 - Protecting Access to Healthcare Act H.R. 5651 - Food and Drug Administration Reform Act of 2012 H.R. 5707 - Medicare Physician Payment Innovation Act of 2012 H.R. 5888 - Physician Reentry Demonstration Program Act H.R. 5998 - USPSTF Transparency and Accountability Act of 2012 S. 1099 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 1855 - Pandemic and All-Hazards Preparedness Act Reauthorization of 2011 S. 2516 - Food and Drug Administration Safety and Innovation Act S. 3201 - Graduate Medical Education Reform Act of 2012 Accountable Care Organizations Final Rule ACS VBU (Value Based-Update) proposal Ambulatory Surgical Centers Cancer programs appropriations Children's Hospitals Graduate Medical Education Payment Program funding CMS EHR Stage 2 Proposed Rule CMS RUC Refinement Electronic Health Record Meaningful Use Stage 2 Proposed Rule Federal Privacy laws Health Information Technology (45 CFR Part 170) HHS ASPR/MSET Program Imaging Inspiring Quality Campaign IPAB Medical Device User Fee and Modernization Act (MDUFMA) Medicare audit programs Medicare fraud identification efforts Medicare Inpatient Prospective Payment System Proposed Rule Medicare Liability Reform Medicare SGR and Overseas Contingency Operations funds NIH Appropriations Nominations for the Committee on Governance and Financing of Graduate Medical Education Nominations for the Medicare Payment Advisory Commission Pediatric subspecialty loan repayment program Prescription Drug User Fee Act (PDUFA) reauthorization Quality and Value Based Purchasing Provisions of Medicare Physician Fee Schedule Final Rule RUC Refinement panel valuation problem Rx Drug and Surgical Workforce shortages Trauma Appropriations

Client expense: $70,254 · Firm income: Not reported

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

See page five for specific HCR issues. H.R. 1409 - Quality Health Care Coalition Act of 2011 H.R. 157 - Health Care Safety Net Enhancement Act of 2011 H.R. 2104 - Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011 H.R. 2119 - Ryan Creedon Act of 2011 H.R. 2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R. 2600 - National Pediatric Acquired Brain Injury Plan Act of 2011 H.R. 3239 - Safeguarding Access For Every Medicare Patient Act H.R. 3474 - PRIME Act of 2011 H.R. 3586 - Good Samaritan Health Professionals Act of 2011 H.R. 4310 - National Defense Authorization Act for Fiscal Year 2013 H.R. 451 - Healthcare Truth and Transparency Act of 2011 H.R. 452 - Medicare Decisions Accountability Act of 2011 H.R. 5 - Protecting Access to Healthcare Act H.R. 5651 - Food and Drug Administration Reform Act of 2012 H.R. 5707 - Medicare Physician Payment Innovation Act of 2012 H.R. 5888 - Physician Reentry Demonstration Program Act H.R. 5998 - USPSTF Transparency and Accountability Act of 2012 S. 1099 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 1855 - Pandemic and All-Hazards Preparedness Act Reauthorization of 2011 S. 2516 - Food and Drug Administration Safety and Innovation Act S. 3201 - Graduate Medical Education Reform Act of 2012 Accountable Care Organizations Final Rule ACS VBU (Value Based-Update) proposal Ambulatory Surgical Centers Cancer programs appropriations Children's Hospitals Graduate Medical Education Payment Program funding CMS EHR Stage 2 Proposed Rule CMS RUC Refinement Electronic Health Record Meaningful Use Stage 2 Proposed Rule Federal Privacy laws Health Information Technology (45 CFR Part 170) HHS ASPR/MSET Program Imaging Inspiring Quality Campaign IPAB Medical Device User Fee and Modernization Act (MDUFMA) Medicare audit programs Medicare fraud identification efforts Medicare Inpatient Prospective Payment System Proposed Rule Medicare Liability Reform Medicare SGR and Overseas Contingency Operations funds NIH Appropriations Nominations for the Committee on Governance and Financing of Graduate Medical Education Nominations for the Medicare Payment Advisory Commission Pediatric subspecialty loan repayment program Prescription Drug User Fee Act (PDUFA) reauthorization Quality and Value Based Purchasing Provisions of Medicare Physician Fee Schedule Final Rule RUC Refinement panel valuation problem Rx Drug and Surgical Workforce shortages Trauma Appropriations

Client expense: $70,254 · Firm income: Not reported

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

See page three for specific Medicare/Medicaid issues. H.R. 1409 - Quality Health Care Coalition Act of 2011 H. R. 1700 The Medicare Patient Empowerment Act H.R. 157 - Health Care Safety Net Enhancement Act of 2011 H.R. 2104 - Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011 H.R. 2119 - Ryan Creedon Act of 2011 H.R. 2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R. 2600 - National Pediatric Acquired Brain Injury Plan Act of 2011 H.R. 3239 - Safeguarding Access For Every Medicare Patient Act H.R. 3474 - PRIME Act of 2011 H.R. 3586 - Good Samaritan Health Professionals Act of 2011 H.R. 4310 - National Defense Authorization Act for Fiscal Year 2013 H.R. 451 - Healthcare Truth and Transparency Act of 2011 H.R. 452 - Medicare Decisions Accountability Act of 2011 H.R. 5 - Protecting Access to Healthcare Act H.R. 5651 - Food and Drug Administration Reform Act of 2012 H.R. 5707 - Medicare Physician Payment Innovation Act of 2012 H.R. 5888 - Physician Reentry Demonstration Program Act H.R. 5937 Breast Cancer Patient Education Act of 2012 H.R. 5998 - USPSTF Transparency and Accountability Act of 2012 H. R. 6043 - Behavioral Health Information Technology Act of 2012 H.R. 6352 - Resident Physician Shortage Reduction and Graduate Medical Education Accountability & Transparency Act H. R. 6598 - Electronic Health Records Improvement Act S. 1099 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 1855 - Pandemic and All-Hazards Preparedness Act Reauthorization of 2011 S. 2516 - Food and Drug Administration Safety and Innovation Act S. 3201 - Graduate Medical Education Reform Act of 2012 Accountable Care Organizations Final Rule ACS VBU (Value Based-Update) proposal Ambulatory Surgical Centers Cancer programs appropriations Children's Hospitals Graduate Medical Education Payment Program funding CMS EHR Stage 2 Proposed Rule CMS RUC Refinement Electronic Health Record Meaningful Use Stage 2 Issues Federal Privacy laws Health Information Technology (45 CFR Part 170) HHS ASPR/MSET Program HAI prevention Imaging Inspiring Quality Campaign IPAB Medical Device User Fee and Modernization Act (MDUFMA) Medicare audit programs Medicare fraud identification efforts Medicare Inpatient Prospective Payment System Proposed Rule Medicare Liability Reform Medicare SGR and Overseas Contingency Operations funds NIH Appropriations Nominations for the Committee on Governance and Financing of Graduate Medical Education Nominations for the Medicare Payment Advisory Commission Pediatric subspecialty loan repayment program Prescription Drug User Fee Act (PDUFA) reauthorization (MMM Continued) Physician Fee Schedule and OPPS/ASC CY 2012 Proposed Rule Physician Quality Reporting System (PQRS) Quality and Value Based Purchasing Provisions of Medicare Physician Fee Schedule Final Rule Risk pool legislation RUC Refinement panel valuation problem Rx Drug and Surgical Workforce shortages Sequestration Surgical Consumer Assessment of Healthcare Providers and Systems (S-CAHPS) Trauma Appropriations Value-Based Update (VBU) Proposal

Client expense: $16,647 · Firm income: Not reported

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

See page six for specific Health Care Issues. H.R. 1409 - Quality Health Care Coalition Act of 2011 H. R. 1700 The Medicare Patient Empowerment Act H.R. 157 - Health Care Safety Net Enhancement Act of 2011 H.R. 2104 - Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011 H.R. 2119 - Ryan Creedon Act of 2011 H.R. 2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R. 2600 - National Pediatric Acquired Brain Injury Plan Act of 2011 H.R. 3239 - Safeguarding Access For Every Medicare Patient Act H.R. 3474 - PRIME Act of 2011 H.R. 3586 - Good Samaritan Health Professionals Act of 2011 H.R. 4310 - National Defense Authorization Act for Fiscal Year 2013 H.R. 451 - Healthcare Truth and Transparency Act of 2011 H.R. 452 - Medicare Decisions Accountability Act of 2011 H.R. 5 - Protecting Access to Healthcare Act H.R. 5651 - Food and Drug Administration Reform Act of 2012 H.R. 5707 - Medicare Physician Payment Innovation Act of 2012 H.R. 5888 - Physician Reentry Demonstration Program Act H.R. 5937 Breast Cancer Patient Education Act of 2012 H.R. 5998 - USPSTF Transparency and Accountability Act of 2012 H. R. 6043 - Behavioral Health Information Technology Act of 2012 H.R. 6352 - Resident Physician Shortage Reduction and Graduate Medical Education Accountability & Transparency Act H. R. 6598 - Electronic Health Records Improvement Act S. 1099 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 1855 - Pandemic and All-Hazards Preparedness Act Reauthorization of 2011 S. 2516 - Food and Drug Administration Safety and Innovation Act S. 3201 - Graduate Medical Education Reform Act of 2012 Accountable Care Organizations Final Rule ACS VBU (Value Based-Update) proposal Ambulatory Surgical Centers Cancer programs appropriations Children's Hospitals Graduate Medical Education Payment Program funding CMS EHR Stage 2 Proposed Rule CMS RUC Refinement Electronic Health Record Meaningful Use Stage 2 Issues Federal Privacy laws Health Information Technology (45 CFR Part 170) HHS ASPR/MSET Program HAI prevention Imaging Inspiring Quality Campaign IPAB Medical Device User Fee and Modernization Act (MDUFMA) Medicare audit programs Medicare fraud identification efforts Medicare Inpatient Prospective Payment System Proposed Rule Medicare Liability Reform Medicare SGR and Overseas Contingency Operations funds NIH Appropriations Nominations for the Committee on Governance and Financing of Graduate Medical Education Nominations for the Medicare Payment Advisory Commission Pediatric subspecialty loan repayment program Prescription Drug User Fee Act (PDUFA) reauthorization (HCR Continued) Physician Fee Schedule and OPPS/ASC CY 2012 Proposed Rule Physician Quality Reporting System (PQRS) Quality and Value Based Purchasing Provisions of Medicare Physician Fee Schedule Final Rule Risk pool legislation RUC Refinement panel valuation problem Rx Drug and Surgical Workforce shortages Sequestration Surgical Consumer Assessment of Healthcare Providers and Systems (S-CAHPS) Trauma Appropriations Value-Based Update (VBU) Proposal

Client expense: $16,647 · Firm income: Not reported

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

See page three for specific Medicare/Medicaid issues. H.R. 1409 - Quality Health Care Coalition Act of 2011 H. R. 1700 The Medicare Patient Empowerment Act H.R. 157 - Health Care Safety Net Enhancement Act of 2011 H.R. 2104 - Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011 H.R. 2119 - Ryan Creedon Act of 2011 H.R. 2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R. 2600 - National Pediatric Acquired Brain Injury Plan Act of 2011 H.R. 3239 - Safeguarding Access For Every Medicare Patient Act H.R. 3474 - PRIME Act of 2011 H.R. 3586 - Good Samaritan Health Professionals Act of 2011 H.R. 4310 - National Defense Authorization Act for Fiscal Year 2013 H.R. 451 - Healthcare Truth and Transparency Act of 2011 H.R. 452 - Medicare Decisions Accountability Act of 2011 H.R. 5 - Protecting Access to Healthcare Act H.R. 5651 - Food and Drug Administration Reform Act of 2012 H.R. 5707 - Medicare Physician Payment Innovation Act of 2012 H.R. 5888 - Physician Reentry Demonstration Program Act H.R. 5937 Breast Cancer Patient Education Act of 2012 H.R. 5998 - USPSTF Transparency and Accountability Act of 2012 H. R. 6043 - Behavioral Health Information Technology Act of 2012 H.R. 6352 - Resident Physician Shortage Reduction and Graduate Medical Education Accountability & Transparency Act H. R. 6598 - Electronic Health Records Improvement Act S. 1099 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 1855 - Pandemic and All-Hazards Preparedness Act Reauthorization of 2011 S. 2516 - Food and Drug Administration Safety and Innovation Act S. 3201 - Graduate Medical Education Reform Act of 2012 Accountable Care Organizations Final Rule ACS VBU (Value Based-Update) proposal Ambulatory Surgical Centers Cancer programs appropriations Children's Hospitals Graduate Medical Education Payment Program funding CMS EHR Stage 2 Proposed Rule CMS RUC Refinement Electronic Health Record Meaningful Use Stage 2 Issues Federal Privacy laws Health Information Technology (45 CFR Part 170) HHS ASPR/MSET Program HAI prevention Imaging Inspiring Quality Campaign IPAB Medical Device User Fee and Modernization Act (MDUFMA) Medicare audit programs Medicare fraud identification efforts Medicare Inpatient Prospective Payment System Proposed Rule Medicare Liability Reform Medicare SGR and Overseas Contingency Operations funds NIH Appropriations Nominations for the Committee on Governance and Financing of Graduate Medical Education Nominations for the Medicare Payment Advisory Commission Pediatric subspecialty loan repayment program Prescription Drug User Fee Act (PDUFA) reauthorization (MMM Continued) Physician Fee Schedule and OPPS/ASC CY 2012 Proposed Rule Physician Quality Reporting System (PQRS) Quality and Value Based Purchasing Provisions of Medicare Physician Fee Schedule Final Rule Risk pool legislation RUC Refinement panel valuation problem Rx Drug and Surgical Workforce shortages Sequestration Surgical Consumer Assessment of Healthcare Providers and Systems (S-CAHPS) Trauma Appropriations Value-Based Update (VBU) Proposal

Client expense: $87,126 · Firm income: Not reported

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

See page six for specific Health Care Issues. H.R. 1409 - Quality Health Care Coalition Act of 2011 H. R. 1700 The Medicare Patient Empowerment Act H.R. 157 - Health Care Safety Net Enhancement Act of 2011 H.R. 2104 - Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011 H.R. 2119 - Ryan Creedon Act of 2011 H.R. 2405 - Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R. 2600 - National Pediatric Acquired Brain Injury Plan Act of 2011 H.R. 3239 - Safeguarding Access For Every Medicare Patient Act H.R. 3474 - PRIME Act of 2011 H.R. 3586 - Good Samaritan Health Professionals Act of 2011 H.R. 4310 - National Defense Authorization Act for Fiscal Year 2013 H.R. 451 - Healthcare Truth and Transparency Act of 2011 H.R. 452 - Medicare Decisions Accountability Act of 2011 H.R. 5 - Protecting Access to Healthcare Act H.R. 5651 - Food and Drug Administration Reform Act of 2012 H.R. 5707 - Medicare Physician Payment Innovation Act of 2012 H.R. 5888 - Physician Reentry Demonstration Program Act H.R. 5937 Breast Cancer Patient Education Act of 2012 H.R. 5998 - USPSTF Transparency and Accountability Act of 2012 H. R. 6043 - Behavioral Health Information Technology Act of 2012 H.R. 6352 - Resident Physician Shortage Reduction and Graduate Medical Education Accountability & Transparency Act H. R. 6598 - Electronic Health Records Improvement Act S. 1099 - Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 S. 1855 - Pandemic and All-Hazards Preparedness Act Reauthorization of 2011 S. 2516 - Food and Drug Administration Safety and Innovation Act S. 3201 - Graduate Medical Education Reform Act of 2012 Accountable Care Organizations Final Rule ACS VBU (Value Based-Update) proposal Ambulatory Surgical Centers Cancer programs appropriations Children's Hospitals Graduate Medical Education Payment Program funding CMS EHR Stage 2 Proposed Rule CMS RUC Refinement Electronic Health Record Meaningful Use Stage 2 Issues Federal Privacy laws Health Information Technology (45 CFR Part 170) HHS ASPR/MSET Program HAI prevention Imaging Inspiring Quality Campaign IPAB Medical Device User Fee and Modernization Act (MDUFMA) Medicare audit programs Medicare fraud identification efforts Medicare Inpatient Prospective Payment System Proposed Rule Medicare Liability Reform Medicare SGR and Overseas Contingency Operations funds NIH Appropriations Nominations for the Committee on Governance and Financing of Graduate Medical Education Nominations for the Medicare Payment Advisory Commission Pediatric subspecialty loan repayment program Prescription Drug User Fee Act (PDUFA) reauthorization (HCR Continued) Physician Fee Schedule and OPPS/ASC CY 2012 Proposed Rule Physician Quality Reporting System (PQRS) Quality and Value Based Purchasing Provisions of Medicare Physician Fee Schedule Final Rule Risk pool legislation RUC Refinement panel valuation problem Rx Drug and Surgical Workforce shortages Sequestration Surgical Consumer Assessment of Healthcare Providers and Systems (S-CAHPS) Trauma Appropriations Value-Based Update (VBU) Proposal

Client expense: $87,126 · Firm income: Not reported

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

Monitor implementation of the Patient Protection and Affordable Care Act. (P.L. 111-148) S. 2113, Transforming the Regulatory Environment to Accelerate Access to Treatments. S. 3295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013. Draft, House Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013. H.R. 4209, Patients' Access to Treatments Act of 2012. H.R. 451, Healthcare Truth and Transparency Act of 2011. H.R. 5707, Medicare Physician Payment Innovation Act of 2012. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act. H.R. 6482, To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings. H.R. 6562, Resident Physician Shortage Reduction Act of 2012. H.R. 8, American Taxpayer Relief Act of 2012. Monitor the implementation of the Continuing Appropriations Resolution, 2013. (P.L. 112-175) Monitor federal issues and legislation associated with health care policy.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Physician Payment Reform: 1) Oppose SGR Cuts 2) New Principles for physician payment - no specific bill HR 5707 - Medicare Physician Payment Innovation Act of 2011 Reclassification of marijuana so that its potential medicinal use by humans may be studied and potentially regulated by the FDA Meaningful Use Requirements; Electronic Prescribing/Electronic Medical Records - no specific bill Sequestration - no specific bill Delaying ICD-10 implementation - no specific bill Oppose proposed elimination of Medicaid payment increases for primary care physicians as providers - no specific bill

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

Government targets: Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, SENATE, White House Office

Medicare Physician Payment Reform: 1) Oppose SGR Cuts 2) New Principles for physician payment - no specific bill HR 5707 - Medicare Physician Payment Innovation Act of 2011 Reclassification of marijuana so that its potential medicinal use by humans may be studied and potentially regulated by the FDA Meaningful Use Requirements; Electronic Prescribing/Electronic Medical Records - no specific bill Sequestration - no specific bill Delaying ICD-10 implementation - no specific bill Oppose proposed elimination of Medicaid payment increases for primary care physicians as providers - no specific bill

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

Government targets: Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, SENATE, White House Office

HR 452, Medicare Decisions Accountability Act of 2011, all sections relating to vision. HR 1219, Optometric Equity in Medicaid Act, all sections relating to vision. HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011, all sections relating to vision. HR 5707, Medicare Physician Payment Innovation Act of 2012, all sections relating to vision. HR 6142, Assuring Medicare Stability and Access for Seniors Act of 2012, all sections relating to vision. S 668, Health Care Bureaucrats Elimination Act, all sections relating to vision. S 2118, Health Care Bureaucrats Elimination Act, all sections relating to vision. S 3337, Access to Physicians in Medicare Act of 2012, all sections relating to vision.

Client expense: $329,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Ambulatory Surgery Center payment issues; Supporting Colorectal Examination and Education Now (SCREEN) Act (H.R. 3198); Implementation of the Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148). Health IT issues; Prescription Drug User Fee Act Reauthorization bills; H.R. 5707 Medicare Physician Payment Innovation Act; H.R. 8, the American Taxpayer Relief Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Ambulatory Surgery Center payment issues; Supporting Colorectal Examination and Education Now (SCREEN) Act (H.R. 3198); Implementation of the Patient Protection & Affordable Care Act (H.R. 3590/Pub.L.No.111-148). Health IT issues; Prescription Drug User Fee Act Reauthorization bills; H.R. 5707 Medicare Physician Payment Innovation Act; H.R. 8, the American Taxpayer Relief Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5707, Medicare Physician Payment Innovation Act of 2012, Issues pertaining to the SGR formula. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act, Issues pertaining to funding for Graduate Medical Education and Indirect Medical Education.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Long Term Acute Care Hospitals, Issues pertaining to funding for the payment structure for Long Term Acute Care Hospitals Medicare and Medicaid Reimbursement, Issues pertaining to Disproportionate Share Hospital payments and possible reductions to provider payments. Medicare and Medicaid Reimbursement, Issues pertaining to Disproportionate Share Hospital payments and possible reductions to provider payments. H.R.6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency ActIssues pertianing to funding for Graduate Medical Education and Indirect Medical Education. H.R. 6611, The Patient Access to Drugs in Shortage Act, Issues pertaining to the 340B program. H.R. 5707, Medicare Physician Payment Innovation Act of 2012, Issues pertaining to the SGR and changes to health delivery. H.R. 6575, The Medicare Audit Improvement Act of 2012, Issues pertaining to RAC audits.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Long Term Acute Care Hospitals, Issues pertaining to innovation at the Center for Medicare and Medicaid Services (CMS). Medicare and Medicaid Reimbursement, Issues pertaining to Disproportionate Share Hospital payments and possible reductions to provider payments. H.R. 5707, Medicare Physician Payment Innovation Act of 2012, Issues pertaining to the SGR and changes to health delivery. H.R.6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act, Issues pertaining to reimbursement for graduate medical education, and disproportionate share hospital payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR3667, GME Modernization pilot program authorization. HR5707, Repeal Medicare SGR; implement primary care centric payment and care system; offset with Overseas Operations Fund, Prevent Medicare physician pay cut effective January 1, 2013. HR5, Protecting Access to Healthcare Act, Medical liability reform, support extension of current payment rate for Medicare. HR5979 Medicaid Accountability and Care Act of 2012, Prevent per capita cap reform of the Medicaid program. HR6688, Averting the Fiscal Cliff Act, American Tax Payer Relief Act, Prevent SGR sequester Medicare payment cuts, protect Medicaid parity primary care rates. Avoid sequester cuts to title VII primary care training grants, GME, AHRQ, NHSC, Prevention and public health trust funds, stop the 2% cut due January 2, 2013. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Meaningful use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Meaningful use funds and quality improvement. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Primary Care meetings. Medical Home and Health Care Reform. No Bill Number, Medicaid payment for primary care, Support for Medicaid payment for primary care services. No Bill Number, Medicaid Expansion, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Patient Centered Medical Homes, Increase support for the model.

Client expense: $633,350 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Veterans Affairs, Dept of (VA), White House Office

HR6688, Averting the Fiscal Cliff Act, American Tax Payer Relief Act, Prevent SGR sequester Medicare payment cuts, protect Medicaid parity primary care rates. Avoid sequester cuts to title VII primary care training grants, GME, AHRQ, NHSC, Prevention and public health trust funds, stop the 2% cut due January 2, 2013 and medical liability reform. HR3667, GME Modernization pilot program authorization. HR5, Protecting Access to Healthcare Act, Medical liability reform. HR5707, Repeal Medicare SGR; implement primary care centric payment and care system; offset with Overseas Operations Fund, Prevent Medicare physician pay cut effective January 1, 2013. HR5979 Medicaid Accountability and Care Act of 2012, Prevent per capita cap reform of the Medicaid program. HR6400, Restoring the Doctors of our Country through scholarships RDOCS Act, Support medical student debt relief, increase family physician workforce. S3295, Department of Labor Appropriations Act, 2013, Support increased FY13 spending on Title VII Sec 747 primary care training grants and AHRQ funding. No Bill Number, Meeting with OMB Public Health Program Examiner, Supporting AAFP federal budgetary priorities. No Bill Number, Coalition for Health Funding Townhall, Supporting AAFP federal budgetary priorities. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Patient Centered Medical Homes, Increase support for the model. No Bill Number, SGR Fix, Stop the 27% cut due to go into effect January 1st, 2013. No Bill Number, Briefing on ONDCP/NIDA e-Learning tools on opioid prescribing, monitor federal activities on tools for prescribers, support policies which do not burden family physicians. No Bill Number, Meeting with ONDCP director to eliminate CME mandates from National Drug Control strategy. No Bill Number, Meeting with AHRQ director on primary care research HIT promotion and work to support family physicians. No Bill Number, Promote expanding primary care physician workforce, Increase family physician workforce. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, Health Insurance Exchanges, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Essential Health Benefits, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Center for Medicare and Medicaid Innovation, Comprehensive Primary Care Initiative. No Bill Number, Medicaid Expansion, Expansion of access to health care coverage for uninsured and underinsured individuals. No Bill Number, Meaningful use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Meaningful use funds and quality improvement. No Bill Number, Medicaid parity for primary care, Ensuring payments for true primary care physicians. No Bill Number, Primary Care meetings. Medical Home and Health Care Reform. No Bill Number, Veterans health, Access of veterans to community physicians. No Bill Number, Health research, Primary care research agenda. No Bill Number, Medicare physician payment system, Support for transition care provision of the payment schedule. No Bill Number, Medicaid payment for primary care, Support for Medicaid payment for primary care services. No Bill Number, Health labels for smokeless tobacco products, Opposition to changes in health safety warning for smokeless tobacco products.

Client expense: $633,350 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, Veterans Affairs, Dept of (VA), White House Office

Health Care Bureaucrats Elimination Act (S. 668) Medicare Physician Payment Innovation Act of 2012 (H.R. 5707) Assuring Medicare Stability and Access for Seniors Act (HR 6142)

Client expense: $30,430 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Office of Natl Drug Control Policy (NDCP), SENATE

Sustainable Growth Rate Formula Reform (general); H.R. 452, Medicare Decisions Accountability Act; S. 688, Health Care Bureaucrats Elimination Act; Imaging (general); Medicaid (general); H.R. 2020/ S.1096, Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act; Strong Start Initiative; Primary care payment bonuses; H.R. 5707, Medicare Physician Payment Innovation Act of 2012. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act; H.R. 3667, Primary Care Workforce Access Improvement Act of 2011; H.R. 3269/S. 2347, Diagnostic Imaging Services Access Protection Act of 2011.

Client expense: $245,727 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office

P.L. 111-148 - Patient Protection and Affordable Care Act Health Information Technology H.R. 2224 - Improving Physician Access in Teaching Hospitals (PATH) Act S. 1052, H.R. 1970 - National Childhood Brain Tumor Prevention Network Act Health workforce shortage issues, Title VII and Title VIII of the Public Health Service Act, nursing, graduate nursing education, nursing-managed health clinics Health wellness and prevention programs H.R. 5707 - Medicare Physician Payment Innovation Act H.R.5651, Food and Drug Administration Reform Act of 2012 H.R. 6352 Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act (Schock Bill combines Schumer/Nelson/Reid bill and Reed RI bills) H.R. 6562 Resident Physician Shortage Reduction Act of 2012

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

HR 2/S 192, Repealing the Job-Killing Health Care Law Act HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 HR 439/S 73, State Leadership in Health Care Act H.R.451, Healthcare Truth and Transparency Act of 2011 H.R.751, Mental Health in Schools Act of 2011 H.R. 831/S 483, To amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare Program S.483, Medicare Mental Health Access Act S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S.539, Behavioral Health Information Technology Act of 2011 S 248/ HR 844, Empowering States to Innovate Act S. 525, Positive Aging Act of 2011 S 650/HR 1184, Health Care Waiver Transparency Act S. 374, Medicare Mental Health Inpatient Equity Act S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. HR 5/S 218, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H Res 92, Providing for consideration of the bill (H.R. 1) making appropriations for the Department of Defense and the other departments and agencies of the Government for the fiscal year ending September 30, 2011, and for other purposes, and waiving a requirement of clause 6(a) of rule XIII with respect to consideration of certain resolutions reported from the Committee on Rules. S. 1542, H.R. 2883, Child and Family Services Improvement and Innovation Act S. 1925, H.R. 4970 Violence against Women Act Reauthorization Act S. 3604, A bill to amend title XVIII of the Social Security Act to provide for the implementation of prescriber education programs and to establish requirements relating to the administration of antipsychotics to residents of skilled nursing facilities and nursing facilities under the Medicare and Medicaid programs, and for other purposes. H.R. 6043, the Behavioral Health Information Technology Act of 2012 H.R. 5989, the Excellence in Mental Health Act of 2012 H.R. 5996, the Mental Health First Aid Higher Education Act of 2012 H.R. 5707, the Medicare Physician Payment Innovation Act of 2012 H. R. 6562, the Resident Physician Shortage Act of 2012 H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act of 2012 H.R. 6079, the Repeal of Obamacare Act H.R. 8, American Taxpayer Relief Act H.R. 6645, Save and Stregthen Medicare Act of 2012 H.R. 6598, Electronic Health Records Improvement Act Proposed Rule on the Patient Protection and Affordable Care Act: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation. CMS-2012-0142-0001.

Client expense: $122,658 · Firm income: Not reported

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

HR 340, To amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid Program of items and services for patients in an institution for mental diseases. HR 831/S 483, to amend title XVIII of the Social Security Act to provide for treatment of clinical psychologists as physicians for purposes of furnishing clinical psychologist services under the Medicare program S.483, Medicare Mental Health Access Act (companion bill to HR 831 above) HR 1256, Medicare Physician Payment Transparency and Assessment Act of 2011 S.37, Autonomy for Psychologists and Social Workers Act of 2011 S.40, Graduate Psychology Education Act of 2011 S.43, Psychologists in the Service of the Public Act of 2011 S 374, Medicare Mental Health Inpatient Equity Act S. 525, Positive Aging Act of 2011 S 539, Behavioral Health Information Technology Act of 2011 S. 1627, Resident Physician Shortage Reduction Act of 2011, A bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. H.R. 6043, the Behavioral Health Information Technology Act of 2012 H.R. 5707, the Medicare Physician Payment Innovation Act of 2012 H.R. 5989, the Excellence in Mental Health Act of 2012 H. R. 6562, the Resident Physician Shortage Act of 2012 H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act of 2012 H.R. 6079, the Repeal of Obamacare Act H.R. 6598, Electronic Health Records Improvement Act H.R. 6645, Save and Strength Medicare Act of 2012 Medicare Program: Revisions to Payment Policies Under the Physician Fee Schedule, DME Face to Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013. (CMS-2012-0083-3524) Medicaid Program: Payments for Services Furnished by Certain Primary Care Physicians and Charges for Vaccine Administration under the Vaccines for Children Program; Correction. (CMS-2012-0061-0150)

Client expense: $122,658 · Firm income: Not reported

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

Expand the authority and types of services that can be reimbursed to doctors of chiropractic under Medicare. PL -111-148 - Patient Protection and Affordable Care Act. H.R. 1700 under Medicare Patient Empowerment Act. PL -111-152 - Patient Protection and Affordable Care Act. PL -111-5 - American Recovery and Reinvestment Act. PL-112-240 American Taxpayer Relief Act S. 756 - Medicare Data Access For Transparency and Accountability Act of 2011. H.R. 1256 - Medicare Physician Payment Transparency and Assessment Act of 2011. H.R. 3765 - Temporary Payroll Tax Cut Continuation Act of 2011. S. 1251 - Medicare and Medicaid Fast Act. H.R. 1700 - Medicare Patient Empowerment Act S. 1042 - Medicare Patient Empowerment Act H.R. 5707 - Medicare Physician Payment Innovation Act of 2012

Client expense: $33,400 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Personnel Management (OPM), President of the U.S., SENATE, Veterans Affairs, Dept of (VA)

Medicare Physician Payment and Quality Issues; Pending cuts in Medicare payments to physicians/SGR repeal. P.L. 111-148/P.L. 111-152, Affordable Care Act: Section 1202, implementation of Medicaid payment increases for primary care services. H.R. 5707, the Medicare Physician Payment Innovation Act. H.R. 8, American Taxpayer Relief Act of 2012: Medicare physician reimbursement; extension of funding for performance measurement.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5707, Medicare Physician Payment Innovation Act; S. 3187, the Food and Drug Administration Safety and Innovation Act; Health IT; Hospital Payments; Health Reform Implementation; Medicaid Funding; Medicare Funding; Physician Payments; Funding for Critical Access Hospitals.

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

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

Presidents Budget, 2013, Department of Health and Human Services Unnumbered House subcommittee bill/S.3295 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for National Institutes of Health (NIH), human embryonic stem cell research, Health Resources and Services Administration (HRSA), Title VII and Title VIII health professions and nursing education programs, National Health Service Corps, Childrens Hospitals graduate medical education (GME), Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and CDCs National Center for Health Statistics. Restore NIH salary cap to Executive Level I. Oppose elimination of AHRQ, and research policy provisions in House subcommittee bill H.R. 6400, RDOCS Act of 2012 Issue: Support additional scholarship opportunities for medical students. President's Budget, 2013, Department of Health and Human Services Issues: Oppose proposed reduction in Medicare Graduate Medical Education (GME) support and proposed Medicaid reductions and reforms. Presidents Budget, 2014, Department of Veterans Affairs H.R. 5854/S. 3215, Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2013, Title II Issues: Support funding for Veterans Affairs medical research, research infrastructure, and health care. P.L. 111-148, Patient Protection and Affordable Care Act, Section 4002 and Title V Issue: Support the Prevention and Public Health Fund and preserve PPHF funds for workforce training. P.L. 111-148, Patient Protection and Affordable Care Act, Title V and Section 10503 Issue: Funding for Community Health Centers and the National Health Service Corps. Debt in Health Education Loan programs (Dbt HELP) bill proposal (draft) Issue: Expand National Health Service Corps State Loan Repayment program, align Department of Education and Health Resources and Services Administration student loan programs. S. 1627, Resident Physician Shortage Reducation Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. P.L. 111-148, Patient Protection and Affordable Care Act, Title V Issue: Implementing provisions reauthorizing health professions education programs under Title VII of the Public Health Service Act, and reauthorizing National Health Service Corps. S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Increase Medicare Graduate Medical Education (GME) accountability H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act Section 5503 and 5506 Issue: Redistribution of residency positions Issue: Implementation of Teaching Health Center Graduate Medical Education programs under section 340G of the Public Health Service Act. H.R. 1852/S. 958, Children's Hospital GME Support Reauthorization Act of 2011 S. 1440, The Prematurity Research Expansion and Education for Mothers who Deliver Infants Early Act. Issue: Support reauthorization of Children's Hospitals Graduate Medical Education. H.R. 1855/H.R. 2405, Pandemic and All-Hazards Preparedness Reauthorization Act. Issue: Complete reauthorization of preparedness legislation Act. H.R. 5707, Medicare Physician Payment Innovation Act Issue: Repeal of Medicare's sustainable growth rate (SGR) formula. H.R. 1513/S. 810, Great Ape Protection and Cost Saving Act of 2011 H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments and increase GME accountability and transparency. H.R. 6562, Resident Physician Reduction Shortage Act of 2012 Issue: Support lifting cap on the number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments. Issue: Promote interprofessional education and training of the health care workforce. S. 799, Commercial Privacy Bill of Rights Act of 2011 Issue: Collection, retention, and dissemination of personal health information. Issue: Discuss with Administration impact of Medicaid expansions and Medicaid DSH cuts under the Affordable Care Act on AAMC member institutions. Issue: Funding for the National Healthcare Workforce Commission. H.R. 2954/S. 2474, Health Equity and Accountability Act of 2011 Issue: Developing health care workforce that promotes health equity. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies Issue: Support Medicare physician payment reform Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Clarify policy changes on how to count Labor and Delivery beds when calculating Medicare GME payments. Issue: Oppose Medicare Graduate Medical Education (GME) spending cuts through sequestration. Issue: 340b Drug Discount program eligibility Issue: Oppose nondefense discretionary spending cuts through sequestration, including NIH and Title VII and VIII health professions and nursing education programs. Issue: Preventing, Identifying, and Treating Prescription Drug Abuse Issue: Primary Care Workforce Development Issue: Funding for Title VII and VIII in President's FY 2014 Budget Issue: Implementation of ACA Exchanges and Medicaid Expansions. Submitted comments on: AHRQ's Consumer Reporting System for Patient Safety Events Enhancing Community-Engaged Research Through the Clinical and Translational Science Awards Program

Client expense: $960,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Reserve System, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Interior, Dept of (DOI), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), White House Office

President's Budget, 2013, Department of Health and Human Services Issue: Oppose proposed reductions in Medicare GME support and proposed reductions and reforms in Medicaid. S. 1627, Resident Physician Shortage Reduction Act Issue: Support lifting the cap on the number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education and Indirect Medical Education payments. Issue: Implementation of Teaching Health Center Graduate Medical Education program under section 340G of the Public Health Service Act. Issue: Health Insurance Exchanges mandated by the Affordable Care Act (ACA) to recognize and not penalize the unique missions of medical schools and teaching hospitals. Issue: Institute of Medicine (IOM) study on Graduate Medical Education (GME) financing and policies. Issue: Support Medicare physician payment reform Issue: Oppose reduction in Medicare hospital outpatient department reimbursement Issue: Oppose restrictions on states' use of Medicaid provider assessments to pay for reduced student loan interest rates. S. 3201 Graduate Medical Education Reform Act of 2012 Issue: Support legislation to increase Medicare GME accountability and support H.R. 3667, Primary Care Workforce Access Improvement Act Issue: Residency training in community-based settings. P.L. 111-148, Affordable Care Act Section 5503 and 5506 (Redistribution of Residency Positions) Issue: Redistribution of residency positions Issue: Support draft legislation to create womens hospital Graduate Medical Education program H.R. 5707, Medicare Physician Payment Innovation Act Issue: Repeal of Medicare's sustainable growth rate (SGR) formula. H.R. 6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments and increase GME accountability and transparancy. H.R. 6562, Resident Physician Reduction Shortage Act of 2012 Issue: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare DGME and IME payments Issue: Discuss with Administration Impact of Medicaid expansions and Medicaid DSH cuts under the Affordable Care Act on AAMC member institutions Issue: Preventing, identifying, and treating prescription drug abuse Issue: Primary Care Workforce Development Issue: Implementation of ACA Exchanges and Medicaid expansions

Client expense: $960,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Reserve System, HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Interior, Dept of (DOI), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Patent & Trademark Office (PTO), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), White House Office

Meidcare/Medicaid equity, H.R. 1509, H.R. 5707, H.R. 6142

Client expense: $497,514 · Firm income: Not reported

Government targets: Air Force, Dept of, Army, Dept of (Corps of Engineers), Army, Dept of (Other), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Congressional Budget Office (CBO), Defense Commissary Agency, Defense Finance & Accounting Service (DFAS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Guard, Natl Oceanic & Atmospheric Administration (NOAA), Navy, Dept of, Office of Management & Budget (OMB), Office of Personnel Management (OPM), Office of the Secretary of Defense, SENATE, U.S. Coast Guard (USCG), U.S. Marines, Veterans Affairs, Dept of (VA), Veterans Employment & Training Service

H.R.5-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 8- American Taxpayer Relief Act of 2012 H.R.157-Health Care Safety Net Enhancement Act of 2011 H.R.314-Medical Liability Procedural Reform Act of 2011 H.R.376-Volunteer Emergency Services Recruitment and Retention Act of 2011 H.R.436-Health Care Cost Reduction Act of 2012 H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.816-Provider Shield Act of 2011 H.R.896-Medical Justice Act of 2011 H.R.969- Medical Practice Freedom Act of 2011 H.R. 971-Critical Care Assessment and Improvement Act of 2011 H.R.1004-Health Flexible Spending Arrangements Improvements Act of 2012 H.R.1117-Air Ambulance Patient Safety, Protection, and Coordination Act H.R. 1063-Strengthening Medicare And Repaying Taxpayers Act of 2011 H.R. 1206- Access to Professional Health Insurance Advisors Act of 2011 H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1310-To amend the Internal Revenue Code of 1986 to exempt certain emergency medical devices from the excise tax on medical devices, and for other purposes H.R.1629-Family Health Care Accessibility Act of 2011 H.R.1668-Danny McIntosh Emergency Medical Service Providers Protection Act H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.1941-Hiring Heroes Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.2205-Ending Defensive Medicine and Encouraging Innovative Reforms Act of 2011 H.R.2353-Volunteer Responder Incentive Protection Reauthorization Act of 2011 H.R.2405-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011 H.R.2472-Health Care Professionals Protection Act of 2011 H.R.2488-SERVE Act of 2011 H.R.2523-Physician Availability Act of 2011 H.R.2853-Emergency Medic Transition (EMT) Act of 2011 H.R.2903-Federal Emergency Management Agency (FEMA) Reauthorization Act of 2012 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.3511- Cardiac Arrest Survival Act of 2011 H.R.3586-Good Samaritans Health Professionals Act of 2011 H.R.3625-Cardiomyopathy Health Education, Awareness, Risk Assessment, and Training in the Schools (HEARTS) Act of 2011 H.R.4124-Veteran Emergency Medical Technician Support Act of 2012 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R.5842-Restoring Access to Medication Act of 2012 H.R.5858-Health Savings Accounts Improvements Act of 2012 H.R. 6079-Repeal of Obama Care Act H.R. 6142-Assuring Medicare Stability and Access for Seniors Act of 2012 H.R. 6163-National Pediatric Research Network Act of 2012 H.R. 6562-Resident Physician Shortage Reduction Act of 2012 H.R. 6672- Pandemic and All-Hazards Preparedness Reauthorization Act of 2012 H.R. 6719- Telehealth Promotion Act of 2012 S.223-FAA Air Transportation Modernization and Safety Improvement Act S.385-Dale Long Emergency Medical Services Providers Protection Act S.668-Health Care Bureaucrats Elimination Act S.868-State Flexibility Act S.932-SERVE Act of 2011 S.933-Volunteer Responder Incentive Protection Reauthorization Act of 2011 S.951-Hiring Heroes Act of 2011 S.958-Children's Hospital GME Support Reauthorization Act of 2011 S.1059-Family Health Care Accessibility Act of 2011 S.1099-Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 S.1407-Air Ambulance Medicare Accreditation and Accountability Act S.1855-Pandemic and All-Hazards Preparedness Reauthorization Act of 2011

Client expense: $695,377 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 8- American Taxpayer Relief Act of 2012 H.R.452-Medicare Decisions Accountability Act of 2011 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1256-Medicare Physician Payment Transparency and Assessment Act of 2011 H.R.1683-State Flexibility Act H.R.1852-Children's Hospital GME Support Reauthorization Act of 2011 H.R.2104-Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act of 2011 H.R.3000-Empowering Patients First Act H.R.3144-Field EMS Quality Innovation and Cost Effectiveness Improvements Act H.R.3269-Diagnostic Imaging Services Protection Act of 2011 H.R.4242-Ensuring Quality Health Care for All Americans Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R. 6142-Assuring Medicare Stability and Access for Seniors Act of 2012 H.R. 6163-National Pediatric Research Network Act of 2012 H.R. 6562-Resident Physician Shortage Reduction Act of 2012 H.R. 6719- Telehealth Promotion Act of 2012 S.868-State Flexibility Act S.958-Children's Hospital GME Support Reauthorization Act of 2011

Client expense: $695,377 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.Con.Res.112-Establishing the budget for the United States Government for fiscal year 2013 and setting forth appropriate budgetary levels for fiscal years 2014 through 2022 H.J. Res. 117-Continuing Appropriations Resolution, 2013 H.R. 8- American Taxpayer Relief Act of 2012 H.R.541-Pay for all your Undocumented Procedures (PAY UP) Act of 2011 H.R.1683-State Flexibility Act H.R.5652-Sequester Replacement Reconciliation Act of 2012 H.R.5707-Medicare Physician Payment Innovation Act of 2012 H.R.5872-Sequestration Transparency Act of 2012 H.R. 6142, Assuring Medicare Stability and Access for Seniors Act of 2012 S.868-State Flexibility Act S.3295-Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2013

Client expense: $695,377 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Reimbursement for physician and hematology services. HR.5707, Medicare Physician Payment Innovation Act.

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

Government targets: Centers For Disease Control & Prevention (CDC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), SENATE

General Medicare Protection, Prescription Drug Reimportation: H.R. 147 and S. 319; Medicare Prescription Drug Improvement: H.R. 3613; Waste and Fraud in Medicare: H.R. 3735, and H.Res. 666; Repeal of Sustainable Growth Rate: H.R. 5707.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR5707, Doc Fix; S.3254, Pharmacy Co-pay.

Client expense: $140,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA)

Medicare Physician Payment and Quality Issues; H.R. 5707, the Medicare Physician Payment Innovation Act Under Budget/Appropriations FY 2013 Labor-HHS-Education Appropriations Bill, funding for the Agency for Health Care Research and Quality Budget Control Act (PL 112-23), impact of sequestration on health programs

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

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

HR5, Protecting Access to Health Are Act, Capping medical liability. HR452, Medicare Decisions Accountability Act, Revamping the independent payment advisory board. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization, Direct GME funding for non-hospital training sites. HR 4013, Temporary Payroll Tax Cut Continuation Act, ten month extension of the Medicare physician fee schedule. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care.

Client expense: $767,597 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, White House Office

HR2119, Ryan Creedon Act, Opposing a requirement that physicians be specifically trained on the dangers of addictive drugs. HR3630, Welfare Integrity and Data Improvement Act, Ten month extension of Medicare physician fee schedule. HR3667, Primary Care Workforce Access Improvement Act of 2011, GME modernization pilot program authorization and funding for non-hospital training sites. HR5, Medical liability reform and IPAB repeal Protecting Access to Healthcare Act, Medical liability reform. HR452, Medicare Decision Accountability Act, Revamping the Independent Payment Advisory Board. HR5707, Medicare Physician Payment Innovation Act of 2012, Replace Medicare physician payment's SGR with higher payment rates for primary care. HR5888, Physician Reentry Demonstration Program Act, Revise bill so sub-specialists do not reenter practice as primary care docs in CHCs, VA clinics and school based centers. S3187, Synthetic Drug Abuse Prevention Act of 2012, discussion on Opioid abuse and pain management as part of PDUFA reauthorization. Support appropriate prescription drug monitoring which is not burdensome to family physicians. S3295, Department of Labor Appropriations Act 2013, Support increased appropriations for Agency for Healthcare Research and Quality in FY2013, AHRQ funding budget priority, Support increased FY13 spending on Title VII Sec 747 primary care training grants. No Bill Number, FDA/CDER meeting on chronic pain management, Effective pain management. No Bill Number, 2013 Family Physician of the Year competition judge. No Bill Number, Protect access to healthcare act, Medical liability reform. No Bill Number, Medicare physician payment reform of the Sustainable Growth Rate, Medicare physician pay cuts scheduled for 2013. No Bill Number, Increasing physician awareness of TBI and PTSD, Promoting family physician ability to assist with these conditions. No Bill Number, Comprehensive Primary Care, Medical Home and Healthcare Reform. No Bill Number, PCPCC Center for Consumer Engagement, Medical Home and Health Care Reform. No Bill Number, Tobacco cessation, Health of the public. No Bill Number, Primary care meeting, Medical Home and Health Care Reform. No Bill Number, Meaningful Use meetings, Medical Home and Health Care Reform. No Bill Number, Electronic Health Records, Ensuring payments for true primary care physicians. No Bill Number, 2013 proposed inpatient PPS, Supporting GME slots for primary care. No Bill Number, Valuation of Primary Care, strategies for improving primary care payment in the physician fee schedule. No Bill Number, Primary care incentive payment PCIP, Re-question CMS release data on PCIP use. No Bill Number, National Priorities and Research Agenda, PCORI should focus research on more common medical conditions first. No Bill Number, National School lunch program, Improve school nutrition programs accessed through state education by providing incentives for school nutrition providers to replace foods with little or no nutritional value. No Bill Number, Oppose repeal of subsidies for health insurance exchanges. No Bill Number, Medicare physician fee schedule for 2013, Support for short term payment reforms to allow primary care access to non face to face codes. No Bill Number, Comprehensive Primary Care Initiative, Promote the CPCI to family physician practices in the seven geographic markets. No Bill Number, Medicaid payments to primary care physicians, Oppose expansion of definition of physicians who are eligible for primary care Medicaid support. No Bill Number, White House meeting on improving health care coordination and quality. Support for Patient Centered Medical Home as a health care delivery model to improve coordination of care. No Bill Number, White House meeting on implementation of meaningful use of HIT, Support for standards of interoperability of HIT systems. No Bill Number, Adequacy and accuracy of Medicare physician payment, Positive payment differential for primary care physicians. No Bill Number, Patient Centered Medical Home, Increasing support for the concept in discussing delivery system reform.

Client expense: $767,597 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), SENATE, White House Office

Long Term Acute Care Hospitals, Issues pertaining to innovation at the Center for Medicare and Medicaid Services (CMS). Medicare and Medicaid Reimbursement, Issues pertaining to Disproportionate Share Hospital payments and possible reductions to provider payments. H.R. 5707, Medicare Physician Payment Innovation Act of 2012, Issues pertaining to the SGR and changes to health delivery. H.R.6352, Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act, Issues pertaining to reimbursement for graduate medical education, and disproportionate share hospital payments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Repeal Sustainable Growth Rate formula; H.R. 452 Medicare Decisions Accountability Act; H.R. 2020 / S. 1096 Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act; H.R. 1700 / S. 1042 Medicare Patient Empowerment Act; H.R. 3613 Part D Beneficiary Appeals Fairness Act; H.R. 5707 Medicare Physician Payment Innovation Act; H.R. 6142 Assuring Medicare Stability and Access for Seniors Act; Monitor implementation of P.L. 111-148; Extension of Section 3111, P.L. 111-148

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

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