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Quality Data, Quality Healthcare Act of 2013
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vs 3,002 other S bills in the 113th — cohort avg 39d
No CRS summary is available for this bill yet. The source title, actions, sponsors, and text versions below come from Congress.gov.
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Filing registrants (6)
2015 · first_quarter · Medicare/Medicaid
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Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic: Extends health insurance to the uninsured Establishes the Patient-Centered Outcomes Research Institute to support comparative effectiveness research Imposes necessary regulations on Insurers - banning rescissions and exclusions for pre-existing medical conditions limits Creates state based Health Insurance Exchanges for individuals between 133% - 400% of Federal Poverty level (FPL) Calls for Value Based Purchasing for all providers Calls for the establishment of Accountable Care Organizations Establishes a Center for Medicare and Medicaid Innovation to test innovative payment and delivery models The following are key elements of the health policy agenda of the Marshfield Clinic: Reform of Medicares Sustainable Growth Rate (HR 2). We believe that the longstanding challenges inherent in fee for service reimbursement under the resource based relative value system, and the financial problems associated with the sustainable growth rate (SGR) formula must be addressed to assure access to Medicare benefits and the future solvency of the Medicare program. We recommend that Congress repeal the SGR formula, and link future updates to measures that reflect the cost and value of providing health care services. Congress must also take steps immediately to create increased incentives for preventative care, care coordination, and primary care services. Medicare Pay for Value Provider accountability for quality and spending growth is an essential element of delivery system reform. Existing law requires that the Centers for Medicare & Medicaid Services (CMS) implement a value modifier that applies to Medicare Part B physician payments for certain physicians and physician groups beginning in calendar year 2015. By 2017, CMS is required to apply the value modifier to all Medicare Part B payments to physicians and physician groups. We recommend that Congress should implement this policy sooner if possible. Score-able savings might be achieved if Congress put a larger percentage of the value modifier at risk for participating physicians, and imposed penalties on inefficient practices. Geographic Adjustment of Physician Payments Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas. CBO Scoring of Preventive Health The budget process should be improved to permit Congress to assess long-term health savings that are possible from preventive health initiatives. Recent research supports the premise that the current budget window should be extended and CBO directed to take into account the relevant disease-progression data that exists which demonstrates savings in preventive health. To ensure that CBOs projections on cost savings are tied to scientific data, preventive health analysis must include credible and publicly available epidemiological projection, incorporating clinical trials or observational studies in humans, longitudinal studies, and meta-analysis. This narrow approach will discourages abuse while encouraging a sensible review of health policy Congress believes will further public health. Transparency Marshfield Clinic supports The Quality Data, Quality Healthcare Act, S. 1758, introduced by Senators Tammy Baldwin (D-WI) and John Thune (R-SD), and similar legislation the Expanding the Availability of Medicare Data Act, HR 4418, introduced by Reps. Ron Kind (D-WI) and Paul Ryan (R-WI). This legislation would provide for greater access to Medicare claims data by modernizing and reforming the Qualified Entity (QE) program, which permits organizations to access and analyze Medicare data. Medicare Advantage Performance Measurement The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Improvements H.R. 2753, THE SECURING CARE FOR SENIORS ACT, by Rep. Diane Black (R-TN), provides seniors with more choice and allows flexibility for plans in the highly successful Medicare Advantage (MA) program through common-sense and technical fixes expanding the Open Enrollment Period; Permitting Incentives for Participation in Health Care Improvement Programs; enabling Cost-sharing Variation; making Improvements to the Risk Adjustment System; and making Improvements to MA 5-Star Quality Rating System. Marshfield Clinic supports this bill. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable care Act. Telemedicine in Medicare Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. Recommendations: 1.Amend the Medicare requirement for non-MSA geographic location of the patient to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. 2.Alternative - amend the Medicare requirement for non-MSA geographic location of the patient to allow accountable care organizations to be exempt from the MSA requirement. Oral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care. Meaningful Use of Health Information Technology The accelerating growth in new medical knowledge, coupled with the birth of new sciences, such as genomics and personalized medicine, suggests that physicians, nurses, and other healthcare professionals will invariably continue to fall further and further behind in their ability to keep up with the latest discoveries and approved treatments. As information technology has sparked this explosive growth in knowledge, only information technology can provide an adequate response. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare. We supported repeal of the Medical Device tax in HR 160 and S 149. We supported funding for farm safety in appropriations. We lobbied against further cuts to Medicare Advantage organizations, and requested assistance with CMS to improve the administration of the laboratory fee schedule, and to remove the cuts to high value 4 and 5 star Medicare Advantage plans included in the Medicare Advantage benchmark cap.
Client expense: $100,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE
2014 · third_quarter · Medicare/Medicaid
General Issues: Coordinated care for dual eligible's, Medicare payment reform, Medicare Advantage quality bonus payment program,insurer tax, Medicaid payment reform, Medicaid Managed Care, Medicare Advantage, Medicare Supplemental, fraud and abuse prevention, high cost drugs, Special Needs Plans reauthorization, Medicare Part D, appropriate use criteria, Medicare Sustainable Growth Rate, and Medicare data transparency. Specific Bills include: H.R. 4418; S. 1758; and, H.R. 4302 (became Public Law 113-93).
Client expense: $1,640,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2014 · third_quarter · Medicare/Medicaid
General Issues: Coordinated care for dual eligible's, Medicare payment reform, Medicare Advantage quality bonus payment program,insurer tax, Medicaid payment reform, Medicaid Managed Care, Medicare Advantage, Medicare Supplemental, fraud and abuse prevention, high cost drugs, Special Needs Plans reauthorization, Medicare Part D, appropriate use criteria, Medicare Sustainable Growth Rate, and Medicare data transparency. Specific Bills include: H.R. 4418; S. 1758; and, H.R. 4302 (became Public Law 113-93).
Client expense: $1,050,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2014 · fourth_quarter · Medicare/Medicaid
General Issues: Coordinated care for dual eligible's, Medicare payment reform, Medicare Advantage quality bonus payment program,insurer tax, Medicaid payment reform, Medicaid Managed Care, Medicare Advantage, Medicare Supplemental, fraud and abuse prevention, high cost drugs, Special Needs Plans reauthorization, Medicare Part D, appropriate use criteria, Medicare Sustainable Growth Rate, and Medicare data transparency. Specific Bills include: H.R. 4418; S. 1758; and, H.R. 4302.
Client expense: $1,730,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2014 · fourth_quarter · Medicare/Medicaid
Medicare physician payment; Medicare coverage; Medicare hospital payment; physician and hospital quality; medical liability reform; electronic health record incentive program; clinical data registries; graduate medical education; health care quality; medical imaging and prior authorization; in-office ancillary services exception. HR 2914, Promoting Integrity in Medicare Act; SGR Repeal and Beneficiary Access Improvement Act; HR 4015/S 2000, SGR Repeal and Medicare Provider Payment Modernization Act; S 2501, Hospital Readmission Accuracy and Accountability Act; S 1932/HR 3890, Better Care, Lower Cost Act; Facilitating Participation in Clinical Data Registries Act; IMPACT Act; S 2552, Medicare Advantage Participant Bill of Rights Act; HR 4282, CARE Act; HR 4930, Advancing Care for Exceptional Kids Act; S 961/HR 36, Health Care Safety Net Enhancement Act; HR 5215, to provide for recommendations for the development and use of clinical data registries; HR 5481, FLEX-IT Act; HR 4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act; HR 4857, Ensuring Equal Access to Treatments Act; S 1758, Quality Data, Quality Healthcare Act; HR 4418, Expanding the Availability of Medicare Data Act; Hospital Improvements for Payment (HIP) Act of 2014; Protecting Integrity in Medicare Act of 2014 (PIMA); HR 647, ABLE Act; S 2461/HR 5364, CHIP Extension and Improvement Act of 2014.
Client expense: $410,000 · Firm income: Not reported
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE
2014 · fourth_quarter · Health Issues
Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Health care coverage and payment options in tax reform discussions Policies affecting nurse practitioner education and workforce Definition of essential health benefits Health information technology and electronic health records Mental health services and violence prevention Draft legislation on reauthorization of the National Quality Forum Coverage and payment for health care services furnished to undocumented immigrant children H.R. 297/S. 1557 - Childrens Hospital GME Support Reauthorization Act H.R. 628/S. 195 - Mental Health in Schools Act H.R. 647 - Achieving a Better Life Experience (ABLE) Act H.R. 669 - Sudden Unexpected Death Data Enhancement and Awareness Act H.R. 1249/S. 1756 - Common Sense Nutrition Disclosure Act H.R. 1281/S. 1417 - Newborn Screening Saves Lives Reauthorization Act H.R. 1427 - Truth in Healthcare Marketing Act H.R. 1791 - Medical Preparedness Allowable Use Act H.R. 1947/H.R. 2642 - Federal Agriculture Reform and Risk Management (FARRM) Act H.R. 2019 - Gabriella Miller Kids First Research Act H.R. 2285 - Strategies to Address Antimicrobial Resistance Act H.R. 2575 - Save American Workers Act H.R. 2663/S. 1422 - To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.R. 2833/S. 2278 - Safeguarding Care of Patients Everywhere (SCOPE) Act H.R. 2986 - Protecting Access to Primary Care Act H.R. 3102 - Nutrition Reform and Work Opportunity Act H.R. 3121 - American Health Care Reform Act H.R. 3147 - Food Labeling Modernization Act H.R. 3306/S. 2662 - Telehealth Enhancement Act H.R. 3471/S. 1696 - Women's Health Protection Act H.R. 3527 - Poison Center Network Act H.R. 3717 - Helping Families in Mental Health Crisis Act H.R. 3742 - Antibiotic Development to Advance Patient Treatment (ADAPT) Act H.R. 4118 - Suspending the Individual Mandate Penalty Law Equals (SIMPLE) Fairness Act H.R. 4290 - Wakefield Act H.R. 4574 - Strengthening Mental Health in Our Communities Act H.R. 4631/S. 2449 - Autism Collaboration, Accountability, Research, Education and Support (Autism CARES) Act H.R. 4673 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 4783 - Promoting Healthy Minds for Safer Communities Act H.R. 4888 - Coordinated Recovery Initiative for Babies (CRIB) Act H.R. 5279 - Sugar-Sweetened Beverages Tax (SWEET) Act S. 264/H.R. 1263 - Excellence in Mental Health Act S. 689 - Mental Health Awareness and Improvement Act S. 696 - Safe Chemicals Act S. 744/H.R. 15 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 954 - Agriculture Reform, Food, and Jobs Act S. 1009 - Chemical Safety Improvement Act S. 1014 - Youth Sports Concussion Act S. 1086 - Safe Child Care Act/Child Care and Development Block Grant Reauthorization Act S. 1152 - Building a Health Care Workforce for the Future Act S. 1417 - Newborn Screening Saves Lives Act S. 1697 - Strong Start for Americas Children Act S. 1758 - Quality Data, Quality Healthcare Act S. 1932/H.R. 3890 - Better Care, Lower Cost Act S. 2047 - Protecting Children from Electronic Cigarette Advertising Act S. 2154 - Emergency Medical Services for Children Reauthorization Act S. 2229 - Expanding Primary Care Access and Workforce Act S. 2434/H.R. 4865 - Family Coverage Act S. 2491 - Medicare Protection Act S. 2581 - Child Nicotine Poisoning Prevention Act S. 2728 - Community-Based Medical Education Act S. 2804 - Family Asthma Act
2014 · fourth_quarter · Medicare/Medicaid
MMM (Medicare and Medicaid) Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic: Extends health insurance to the uninsured Establishes the Patient-Centered Outcomes Research Institute to support comparative effectiveness research Imposes necessary regulations on Insurers - banning rescissions and exclusions for pre-existing medical conditions limits Creates state based Health Insurance Exchanges for individuals between 133% - 400% of Federal Poverty level (FPL) Calls for Value Based Purchasing for all providers Calls for the establishment of Accountable Care Organizations Establishes a Center for Medicare and Medicaid Innovation to test innovative payment and delivery models The following are key elements of the health policy agenda of the Marshfield Clinic: Medicares Sustainable Growth Rate We believe that the longstanding challenges inherent in fee for service reimbursement under the resource based relative value system, and the financial problems associated with the sustainable growth rate (SGR) formula must be addressed to assure access to Medicare benefits and the future solvency of the Medicare program. We recommend that Congress repeal the SGR formula, and link future updates to measures that reflect the cost and value of providing health care services. Congress must also take steps immediately to create increased incentives for preventative care, care coordination, and primary care services. Medicare Pay for Value Provider accountability for quality and spending growth is an essential element of delivery system reform. Existing law requires that the Centers for Medicare & Medicaid Services (CMS) implement a value modifier that applies to Medicare Part B physician payments for certain physicians and physician groups beginning in calendar year 2015. By 2017, CMS is required to apply the value modifier to all Medicare Part B payments to physicians and physician groups. We recommend that Congress should implement this policy sooner if possible. Score-able savings might be achieved if Congress put a larger percentage of the value modifier at risk for participating physicians, and imposed penalties on inefficient practices. Geographic Adjustment of Physician Payments Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas. CBO Scoring of Preventive Health The budget process should be improved to permit Congress to assess long-term health savings that are possible from preventive health initiatives. Recent research supports the premise that the current budget window should be extended and CBO directed to take into account the relevant disease-progression data that exists which demonstrates savings in preventive health. To ensure that CBOs projections on cost savings are tied to scientific data, preventive health analysis must include credible and publicly available epidemiological projection, incorporating clinical trials or observational studies in humans, longitudinal studies, and meta-analysis. This narrow approach will discourages abuse while encouraging a sensible review of health policy Congress believes will further public health. Transparency Marshfield Clinic supports The Quality Data, Quality Healthcare Act, S. 1758, introduced by Senators Tammy Baldwin (D-WI) and John Thune (R-SD), and similar legislation the Expanding the Availability of Medicare Data Act, HR 4418, introduced by Reps. Ron Kind (D-WI) and Paul Ryan (R-WI). This legislation would provide for greater access to Medicare claims data by modernizing and reforming the Qualified Entity (QE) program, which permits organizations to access and analyze Medicare data. Medicare Advantage Performance Measurement The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Improvements H.R. 2753, THE SECURING CARE FOR SENIORS ACT, by Rep. Diane Black (R-TN), provides seniors with more choice and allows flexibility for plans in the highly successful Medicare Advantage (MA) program through common-sense and technical fixes expanding the Open Enrollment Period; Permitting Incentives for Participation in Health Care Improvement Programs; enabling Cost-sharing Variation; making Improvements to the Risk Adjustment System; and making Improvements to MA 5-Star Quality Rating System. Marshfield Clinic supports this bill. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable care Act. Telemedicine in Medicare Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. Recommendations: 1.Amend the Medicare requirement for non-MSA geographic location of the patient to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. 2.Alternative - amend the Medicare requirement for non-MSA geographic location of the patient to allow accountable care organizations to be exempt from the MSA requirement. Oral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care. Meaningful Use of Health Information Technology The accelerating growth in new medical knowledge, coupled with the birth of new sciences, such as genomics and personalized medicine, suggests that physicians, nurses, and other healthcare professionals will invariably continue to fall further and further behind in their ability to keep up with the latest discoveries and approved treatments. As information technology has sparked this explosive growth in knowledge, only information technology can provide an adequate response. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare.
2014 · third_quarter · Health Issues
Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Health care coverage and payment options in tax reform discussions Policies affecting nurse practitioner education and workforce Definition of essential health benefits Health information technology and electronic health records Mental health services and violence prevention Draft legislation on reauthorization of the National Quality Forum Coverage and payment for health care services furnished to undocumented immigrant children H.R. 297/S. 1557 - Childrens Hospital GME Support Reauthorization Act H.R. 628/S. 195 - Mental Health in Schools Act H.R. 669 - Sudden Unexpected Death Data Enhancement and Awareness Act H.R. 1249/S. 1756 - Common Sense Nutrition Disclosure Act H.R. 1281/S. 1417 - Newborn Screening Saves Lives Reauthorization Act H.R. 1427 - Truth in Healthcare Marketing Act H.R. 1791 - Medical Preparedness Allowable Use Act H.R. 1947/H.R. 2642 - Federal Agriculture Reform and Risk Management (FARRM) Act H.R. 2019 - Gabriella Miller Kids First Research Act H.R. 2285 - Strategies to Address Antimicrobial Resistance Act H.R. 2575 - Save American Workers Act H.R. 2663/S. 1422 - To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.R. 2833/S. 2278 - Safeguarding Care of Patients Everywhere (SCOPE) Act H.R. 2986 - Protecting Access to Primary Care Act H.R. 3102 - Nutrition Reform and Work Opportunity Act H.R. 3121 - American Health Care Reform Act H.R. 3147 - Food Labeling Modernization Act H.R. 3306/S. 2662 - Telehealth Enhancement Act H.R. 3471/S. 1696 - Women's Health Protection Act H.R. 3527 - Poison Center Network Act H.R. 3717 - Helping Families in Mental Health Crisis Act H.R. 3742 - Antibiotic Development to Advance Patient Treatment (ADAPT) Act H.R. 4118 - Suspending the Individual Mandate Penalty Law Equals (SIMPLE) Fairness Act H.R. 4290 - Wakefield Act H.R. 4574 - Strengthening Mental Health in Our Communities Act H.R. 4631/S. 2449 - Autism Collaboration, Accountability, Research, Education and Support (Autism CARES) Act H.R. 4673 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 4783 - Promoting Healthy Minds for Safer Communities Act H.R. 4888 - Coordinated Recovery Initiative for Babies (CRIB) Act H.R. 5279 - Sugar-Sweetened Beverages Tax (SWEET) Act S. 264/H.R. 1263 - Excellence in Mental Health Act S. 689 - Mental Health Awareness and Improvement Act S. 696 - Safe Chemicals Act S. 744/H.R. 15 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 954 - Agriculture Reform, Food, and Jobs Act S. 1009 - Chemical Safety Improvement Act S. 1014 - Youth Sports Concussion Act S. 1086 - Safe Child Care Act/Child Care and Development Block Grant Reauthorization Act S. 1152 - Building a Health Care Workforce for the Future Act S. 1417 - Newborn Screening Saves Lives Act S. 1697 - Strong Start for Americas Children Act S. 1758 - Quality Data, Quality Healthcare Act S. 1932/H.R. 3890 - Better Care, Lower Cost Act S. 2047 - Protecting Children from Electronic Cigarette Advertising Act S. 2154 - Emergency Medical Services for Children Reauthorization Act S. 2229 - Expanding Primary Care Access and Workforce Act S. 2434/H.R. 4865 - Family Coverage Act S. 2491 - Medicare Protection Act S. 2581 - Child Nicotine Poisoning Prevention Act S. 2728 - Community-Based Medical Education Act S. 2804 - Family Asthma Act
2014 · third_quarter · Medicare/Medicaid
General Issues: Coordinated care for dual eligible's, Medicare payment reform, Medicare Advantage quality bonus payment program, insurer tax, Medicaid payment reform, Medicaid Managed Care, Medicare Advantage, Medicare Supplemental, fraud and abuse prevention, high cost drugs, Special Needs Plans reauthorization, Medicare Part D, appropriate use criteria, Medicare Sustainable Growth Rate, and Medicare data transparency.Specific Bills include: H.R. 4418; S. 1758; and, H.R. 4302 (became Public Law 113-93).
Client expense: $1,050,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2014 · third_quarter · Medicare/Medicaid
Medicare physician payment; clinical data registries; graduate medical education; health care quality; medical imaging and prior authorization; in-office ancillary services exception; HR 2914, Promoting Integrity in Medicare Act; SGR Repeal and Beneficiary Access Improvement Act of 2014; HR 4015/S 2000, SGR Repeal and Medicare Provider Payment Modernization Act; S 2501, Hospital Readmission Accuracy and Accountability Act; S 1932/HR 3890, Better Care, Lower Cost Act; IMPACT Act;S 2552, Medicare Advantage Participant Bill of Rights Act; HR 4282, CARE Act; HR 4930, Advancing Care for Exceptional Kids Act; S 961/HR 36, Health Care Safety Net Enhancement Act; Facilitating Participation in Clinical Data Registries Act; HR 4188, Establishing Beneficiary Equity in the Hospital Readmission Program Act; HR 4857, Ensuring Equal Access to Treatments Act; S 1758, Quality Data, Quality Healthcare Act; HR 4418, Expanding the Availability of Medicare Data Act.
Client expense: $850,000 · Firm income: Not reported
2014 · third_quarter · Medicare/Medicaid
Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic: Extends health insurance to the uninsured Establishes the Patient-Centered Outcomes Research Institute to support comparative effectiveness research Imposes necessary regulations on Insurers - banning rescissions and exclusions for pre-existing medical conditions limits Creates state based Health Insurance Exchanges for individuals between 133% - 400% of Federal Poverty level (FPL) Calls for Value Based Purchasing for all providers Calls for the establishment of Accountable Care Organizations Establishes a Center for Medicare and Medicaid Innovation to test innovative payment and delivery models The following are key elements of the health policy agenda of the Marshfield Clinic: Medicares Sustainable Growth Rate We believe that the longstanding challenges inherent in fee for service reimbursement under the resource based relative value system, and the financial problems associated with the sustainable growth rate (SGR) formula must be addressed to assure access to Medicare benefits and the future solvency of the Medicare program. We recommend that Congress repeal the SGR formula, and link future updates to measures that reflect the cost and value of providing health care services. Congress must also take steps immediately to create increased incentives for preventative care, care coordination, and primary care services. Medicare Pay for Value Provider accountability for quality and spending growth is an essential element of delivery system reform. Existing law requires that the Centers for Medicare & Medicaid Services (CMS) implement a value modifier that applies to Medicare Part B physician payments for certain physicians and physician groups beginning in calendar year 2015. By 2017, CMS is required to apply the value modifier to all Medicare Part B payments to physicians and physician groups. We recommend that Congress should implement this policy sooner if possible. Score-able savings might be achieved if Congress put a larger percentage of the value modifier at risk for participating physicians, and imposed penalties on inefficient practices. Geographic Adjustment of Physician Payments Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas. CBO Scoring of Preventive Health The budget process should be improved to permit Congress to assess long-term health savings that are possible from preventive health initiatives. Recent research supports the premise that the current budget window should be extended and CBO directed to take into account the relevant disease-progression data that exists which demonstrates savings in preventive health. To ensure that CBOs projections on cost savings are tied to scientific data, preventive health analysis must include credible and publicly available epidemiological projection, incorporating clinical trials or observational studies in humans, longitudinal studies, and meta-analysis. This narrow approach will discourages abuse while encouraging a sensible review of health policy which will further public health. Transparency Marshfield Clinic supports The Quality Data, Quality Healthcare Act, S. 1758, introduced by Senators Tammy Baldwin (D-WI) and John Thune (R-SD), and similar legislation the Expanding the Availability of Medicare Data Act, HR 4418, introduced by Reps. Ron Kind (D-WI) and Paul Ryan (R-WI). This legislation would provide for greater access to Medicare claims data by modernizing and reforming the Qualified Entity (QE) program, which permits organizations to access and analyze Medicare data. Medicare Advantage Performance Measurement The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Improvements H.R. 2753, THE SECURING CARE FOR SENIORS ACT, by Rep. Diane Black (R-TN), provides seniors with more choice and allows flexibility for plans in the highly successful Medicare Advantage (MA) program through common-sense and technical fixes expanding the Open Enrollment Period; Permitting Incentives for Participation in Health Care Improvement Programs; enabling Cost-sharing Variation; making Improvements to the Risk Adjustment System; and making Improvements to MA 5-Star Quality Rating System. Marshfield Clinic supports this bill. Adequate Funding for CMS The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable care Act. Telemedicine in Medicare Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. Recommendations: 1.Amend the Medicare requirement for non-MSA geographic location of the patient to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. 2.Alternative - amend the Medicare requirement for non-MSA geographic location of the patient to allow accountable care organizations to be exempt from the MSA requirement. Oral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care. Meaningful Use of Health Information Technology The growth in new medical knowledge, coupled with the birth of new sciences, such as genomics and personalized medicine, suggests that physicians, nurses, and other healthcare professionals will invariably continue to fall further and further behind in their ability to keep up with the latest discoveries and approved treatments. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare. Personalized medicine, the tailoring of medical treatments to patient characteristics, allows clinicians to target preventive or therapeutic interventions on those who will benefit, and thereby spare the expense and side effects of treatment for those who will not, thus making medicine more efficient. This should be supported.
2014 · second_quarter · Health Issues
Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Health care coverage and payment options in tax reform discussions Policies affecting nurse practitioner education and workforce Definition of essential health benefits Health information technology and electronic health records Mental health services and violence prevention Draft legislation on reauthorization of the National Quality Forum Coverage and payment for health care services furnished to undocumented immigrant children H.R. 297/S. 1557 - Childrens Hospital GME Support Reauthorization Act H.R. 628/S. 195 - Mental Health in Schools Act H.R. 669 - Sudden Unexpected Death Data Enhancement and Awareness Act H.R. 1249/S. 1756 - Common Sense Nutrition Disclosure Act H.R. 1281/S. 1417 - Newborn Screening Saves Lives Reauthorization Act H.R. 1427 - Truth in Healthcare Marketing Act H.R. 1791 - Medical Preparedness Allowable Use Act H.R. 1947/H.R. 2642 - Federal Agriculture Reform and Risk Management (FARRM) Act H.R. 2019 - Gabriella Miller Kids First Research Act H.R. 2285 - Strategies to Address Antimicrobial Resistance Act H.R. 2575 - Save American Workers Act H.R. 2663/S. 1422 - To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.R. 2833/S. 2278 - Safeguarding Care of Patients Everywhere (SCOPE) Act H.R. 2986 - Protecting Access to Primary Care Act H.R. 3102 - Nutrition Reform and Work Opportunity Act H.R. 3121 - American Health Care Reform Act H.R. 3147 - Food Labeling Modernization Act H.R. 3306 - Telehealth Enhancement Act H.R. 3527 - Poison Center Network Act H.R. 3717 - Helping Families in Mental Health Crisis Act H.R. 3742 - Antibiotic Development to Advance Patient Treatment (ADAPT) Act H.R. 4118 - Suspending the Individual Mandate Penalty Law Equals (SIMPLE) Fairness Act H.R. 4290 - Wakefield Act H.R. 4574 - Strengthening Mental Health in Our Communities Act H.R. 4631/S. 2449 - Autism Collaboration, Accountability, Research, Education and Support (Autism CARES) Act H.R. 4663 - Protect Patient Access and Promote Hospital Efficiency Act H.R. 4673 - Bundling and Coordinating Post-Acute Care (BACPAC) Act H.R. 4783 - Promoting Healthy Minds for Safer Communities Act H.R. 4888 - Coordinated Recovery Initiative for Babies (CRIB) Act S. 264/H.R. 1263 - Excellence in Mental Health Act S. 689 - Mental Health Awareness and Improvement Act S. 696 - Safe Chemicals Act S. 744/H.R. 15 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 954 - Agriculture Reform, Food, and Jobs Act S. 1009 - Chemical Safety Improvement Act S. 1014 - Youth Sports Concussion Act S. 1086 - Safe Child Care Act/Child Care and Development Block Grant Reauthorization Act S. 1152 - Building a Health Care Workforce for the Future Act S. 1417 - Newborn Screening Saves Lives Act S. 1697 - Strong Start for Americas Children Act S. 1758 - Quality Data, Quality Healthcare Act S. 1932/H.R. 3890 - Better Care, Lower Cost Act S. 2154 - Emergency Medical Services for Children Reauthorization Act S. 2229 - Expanding Primary Care Access and Workforce Act S. 2434/H.R. 4865 - Family Coverage Act S. 2461 - Childrens Health Insurance Program Reauthorization Act S. 2491 - Medicare Protection Act
2014 · second_quarter · Medicare/Medicaid
General Issues: Coordinated care for dual eligible's, Medicare payment reform, Medicare Advantage quality bonus payment program, insurer tax, Medicaid payment reform, Medicaid Managed Care, Medicare Advantage, Medicare Supplemental, fraud and abuse prevention, high cost drugs, Special Needs Plans reauthorization, Medicare Part D, appropriate use criteria, Medicare Sustainable Growth Rate, and Medicare data transparency.Specific Bills include: H.R. 4418; S. 1758; and, H.R. 4302 (became Public Law 113-93).
Client expense: $1,580,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office
2014 · second_quarter · Medicare/Medicaid
Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic: Extends health insurance to the uninsured Establishes the Patient-Centered Outcomes Research Institute to support comparative effectiveness researchImposes necessary regulations on Insurers banning rescissions and exclusions for pre-existing medical conditions limits Expands Medicaid Eligibility to 133% of FPL Creates state based Health Insurance Exchanges for individuals between 133% - 400% of Federal Poverty level (FPL) Increases practice expense payments, Calls for IOM study to Correct Geographic payment disparities Calls for CMS to establish a Value Index to align payment with quality Establishes Bonus payments for primary care, efficiency, quality Calls for Value Based Purchasing for all providers Calls for the establishment of Accountable Care Organizations Establishes a Center for Medicare and Medicaid Innovation to test innovative payment and delivery models The following are key elements of the health policy agenda of the Marshfield Clinic: Medicares Sustainable Growth Rate -- We believe that the longstanding challenges inherent in fee for service reimbursement under the resource based relative value system, and the financial problems associated with the sustainable growth rate (SGR) formula must be addressed to assure access to Medicare benefits and the future solvency of the Medicare program. We recommend that Congress repeal the SGR formula, and link future updates to measures that reflect the cost and value of providing health care services. Congress must also take steps immediately to create increased incentives for preventative care, care coordination, and primary care services. Physician spending is currently only a fraction of total health care spending but it affects nearly all other aspects of health care delivery. We recommend that Congress utilize the leverage of physician spending to deal with the misaligned incentives in the Medicare program that lead to higher costs and inefficiencies throughout the spectrum of health care delivery. We recommend that new evidence-based measures of quality performance be developed to capture outcomes of care processes. We recommend that Congress fund the work of HHS and CMS to identify and vet better performance measures to support a new physician payment system, especially measures that are focused on outcomes, patient experience of care, care coordination, appropriateness of care, and total resource use. Medicare Pay for Value -- Provider accountability for quality and spending growth is an essential element of delivery system reform. Existing law requires that the Centers for Medicare & Medicaid Services (CMS) implement a value modifier that applies to Medicare Part B physician payments for certain physicians and physician groups beginning in calendar year 2015. By 2017, CMS is required to apply the value modifier to all Medicare Part B payments to physicians and physician groups. We recommend that Congress should implement this policy sooner if possible. Score-able savings might be achieved if Congress put a larger percentage of the value modifier at risk for participating physicians, and imposed penalties on inefficient practices. Geographic Adjustment of Physician Payments - Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas. CBO Scoring of Preventive Health -The budget process should be improved to permit Congress to assess long-term health savings that are possible from preventive health initiatives. Recent research supports the premise that the current budget window should be extended and CBO directed to take into account the relevant disease-progression data that exists which demonstrates savings in preventive health. To ensure that CBOs projections on cost savings are tied to scientific data, preventive health analysis must include credible and publicly available epidemiological projection, incorporating clinical trials or observational studies in humans, longitudinal studies, and meta-analysis. This narrow approach will discourages abuse while encouraging a sensible review of health policy Congress believes will further public health.Value Based Purchasing - The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. Recommendations: Medicare and other payors must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Medicare Payment Inequities - In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. The Update formula for physician services is inequitable because it treats all physicians and regions of the country alike regardless of their individual volume influencing behavior. If the problem of cost is related to the volume of services provided, shouldnt payment be volume adjusted for specific localities? Why should conservative practices and States be punished for the excessive volume of other localities? Payment Equity for Physician Work - There is no difference in the work of physicians in different locations regardless of where the work occurs. We believe that physician work should not be adjusted for geographic location. What is the rational for paying physicians more in many geographic areas when those same areas have apparently ample numbers of physicians and their wages are trending below physician wages in other areas? Should the Medicare program subsidize physicians who chose to live in high cost areas? Recommendation: the geographic adjustment of physician work should be eliminated entirely on a Budget neutral basis. Transparency -- Marshfield Clinic supports The Quality Data, Quality Healthcare Act, S. 1758, introduced by Senators Tammy Baldwin (D-WI) and John Thune (R-SD), and similar legislation the Expanding the Availability of Medicare Data Act, HR 4418, introduced by Reps. Ron Kind (D-WI) and Paul Ryan (R-WI). This legislation would provide for greater access to Medicare claims data by modernizing and reforming the Qualified Entity (QE) program, which permits organizations to access and analyze Medicare data. Medicare Advantage Performance Measurement - The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Improvements -H.R. 2753, THE SECURING CARE FOR SENIORS ACT, by Rep. Diane Black (R-TN), provides seniors with more choice and allows flexibility for plans in the highly successful Medicare Advantage (MA) program through common-sense and technical fixes expanding the Open Enrollment Period; Permitting Incentives for Participation in Health Care Improvement Programs; enabling Cost-sharing Variation; making Improvements to the Risk Adjustment System; and making Improvements to MA 5-Star Quality Rating System. Marshfield Clinic supports this bill. Accountable Care Organizations - The Affordable Care Act seeks to improve the quality of health care services and to lower health care costs by encouraging providers to create integrated health care delivery systems. These integrated systems will test new reimbursement methods intended to create incentives for health care providers to enhance health care quality and lower costs. One important delivery system reform is the Medicare Shared Savings Program under section 3022 of the Affordable Care Act, which promotes the formation and operation of accountable care organizations (ACOs). Under this provision, groups of providers meeting the criteria specified by the Secretary may work together to manage and coordinate care for Medicare beneficiaries through an [ACO]. An ACO may receive payments for shared savings if the ACO meets certain quality performance standards and cost savings requirements established by the Secretary.The basic shared savings model outlined in the statute provides a bonus payment to ACOs that meet quality targets and keep spending for the population for whom the ACO is responsible below a target level. The amount of the bonus payment will depend on the amount of savings and the proportion of the savings allocated to the ACO and Medicare ACOs should report a focused set of quality indicators that reflect the outcomes ACOs are designed to achieve: keeping the population healthy, better care coordination to reduce unnecessary and sometimes harmful spending, and better patient experience. We recommend that CMS relax restrictions on the provision of services using telemedicine technologies to allow ACOs to increase the efficiency of services provided. Adequate Funding for CMS -The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable care Act. Telemedicine in Medicare -Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. Recommendations: 1.Amend the Medicare requirement for non-MSA geographic location of the patient to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. 2.Alternative amend the Medicare requirement for non-MSA geographic location of the patient to allow accountable care organizations to be exempt from the MSA requirement. Community Health Centers Under Health Reform -- The Affordable Care Act contained a number of key provisions relating to community health centers, including new funding for the community health center program and funding to expand the National Health Service Corp. While these are mandatory funding levels, the Congress did cut the base funding levels for community health centers. Americas Health Centers like Family Health Center of Marshfield, Inc. currently serve as the health care home for more than 22 million Americans, providing comprehensive primary and preventive care services. Americas Health Centers play an important role in delivering care to many Americans and could be the health care home for many more, but unless Congress and the Administration act, funding for the Health Center program will be cut by 70%. A cut of this size would force Health Centers to close their doors, lay off staff, and reduce the services they provide, leaving millions of Americans without access to the health care services they need. We ask the Congress to provide not only the funding to preserve ongoing Health Center services but to also expand this cost effective model of care to every community especially those that currently lack basic primary care services. Dental Access and Integration with Traditional Medicine - The Institute of Medicine (IOM) released a report, Dental Education at the Crossroads: Challenges and Change in January 1995 which called for a strong cohesion between medicine and dentistry. The IOM report states that "Dentistry will and should become more closely integrated with medicine and the health care system on all levels: research, education, and patient care. The National Institutes of Health has supported research documenting the importance of oral health in the context of general health and well being. Studies have demonstrated numerous oral-systemic interactions that underscore the need for more integrated care delivery. As our nation embraces EHR technologies, science underscores the need to fully incorporate oral health within an integrated EHR. Marshfield Clinic is simultaneously addressing the issue of dental access and integration with traditional medicine. Family Health Center of Marshfield, Inc. has been providing on-site dental services since the fall of 2002 and operates eight dental sites. As part of this initiative, Marshfield Clinic has developed a comprehensive medical-dental integrated electronic health record (iEHR) environment. CattailsMD, the internally developed electronic health record at Marshfield Clinic in Wisconsin, is one of the oldest electronic medical records systems in the country, with coded diagnoses back to 1960. More recently a dental module, CattailsDental has been integrated and successfully rolled out in all of the seven dental centers across Central and Northern Wisconsin. Using technology to integrate medical and dental health records holds great promise to improve the quality, safety, efficiency, effectiveness and continuity of patient care by enhancing communication and teamwork between physicians and dentists.A comprehensive approach to primary care delivery, demonstrated by Marshfield Clinic and community health centers nationwide, can best be supported with an equally comprehensive EHR infrastructure for both medical and dental records. Oral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care. Meaningful Use of Health Information Technology The accelerating growth in new medical knowledge, coupled with the birth of new sciences, such as genomics and personalized medicine, suggests that physicians, nurses, and other healthcare professionals will invariably continue to fall further and further behind in their ability to keep up with the latest discoveries and approved treatments. As information technology has sparked this explosive growth in knowledge, only information technology can provide an adequate response. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare. Health IT on a broad basis is still in its infancy. Looking to what can be achieved in the future due to implementation of these systems should be our focus, and an ongoing oversight function of the Office of the National Coordinator for HIT which must be closely integrated with Medicare reimbursement. Personalized Medicine Personalized medicine, the tailoring of medical treatments to patient characteristics, relies upon the ability to classify individuals into subpopulations that differ in disease susceptibility and treatment responses. It allows clinicians to target preventive or therapeutic interventions on those who will benefit, and thereby to spare the expense and side effects of treatment for those who will not, thus making medicine more efficient. If the multiple population groups in the United States and elsewhere in the world are to benefit fully and fairly from such research, a national resource operated as a trust for the public good must be established to conduct a large populationbased cohort study that includes full representation of minority populations. The Federal government should make critical investments in the enabling tools and resources essential to moving beyond genomic discoveries to personalized medicine services of patient and public benefit.
2014 · first_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing HealthDraft legislation to repeal the Medicare sustainable growth rate and reform fee-for-service payment Delay of the scheduled implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare hospice certification requirements Medicare skilled nursing facility conditions of participation Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration H.R. 351/S. 351 Protecting Seniors Access to Medicare Act H.R. 574 Medicare Physician Payment Innovation Act H.R. 2524/S. 1228 Medicare Better Health Rewards Act H.R. 2810 Medicare Patient Access and Quality Improvement Act H.R. 2817 Protect Patient Access to Quality Health Professionals Act S.1758 Quality Data, Quality Healthcare Act
2014 · first_quarter · Medicare/Medicaid
Many aspects of the Affordable Care Act promote changes that are consistent with the mission of the Marshfield Clinic: oExtends health insurance to the uninsured oEstablishes the Patient-Centered Outcomes Research Institute to support comparative effectiveness research oImposes necessary regulations on Insurers - banning rescissions and exclusions for pre-existing medical conditions limitsExpands Medicaid Eligibility to 133% of FPL Creates state based Health Insurance Exchanges for individuals between 133% - 400% of Federal Poverty level (FPL) Increases practice expense payments, Calls for IOM study to Correct Geographic payment disparities Calls for CMS to establish a Value Index to align payment with quality Establishes Bonus payments for primary care, efficiency, quality Calls for Value Based Purchasing for all providers Calls for the establishment of Accountable Care Organizations Establishes a Center for Medicare and Medicaid Innovation to test innovative payment and delivery models The following are key elements of the health policy agenda of the Marshfield Clinic: Medicares Sustainable Growth Rate We believe that the longstanding challenges inherent in fee for service reimbursement under the resource based relative value system, and the financial problems associated with the sustainable growth rate (SGR) formula must be addressed to assure access to Medicare benefits and the future solvency of the Medicare program. We recommend that Congress repeal the SGR formula, and link future updates to measures that reflect the cost and value of providing health care services. Congress must also take steps immediately to create increased incentives for preventative care, care coordination, and primary care services. Physician spending is currently only a fraction of total health care spending but it affects nearly all other aspects of health care delivery. We recommend that Congress utilize the leverage of physician spending to deal with the misaligned incentives in the Medicare program that lead to higher costs and inefficiencies throughout the spectrum of health care delivery. We recommend that new evidence-based measures of quality performance be developed to capture outcomes of care processes. We recommend that Congress fund the work of HHS and CMS to identify and vet better performance measures to support a new physician payment system, especially measures that are focused on outcomes, patient experience of care, care coordination, appropriateness of care, and total resource use. The Senate Finance Committee doc fix bill to replace the Sustainable Growth Rate physician payment formula (S 1871) would extend or make permanent several of the health payment policies. Both the Energy and Commerce and the House Ways and Means Committee approved versions of a similar bill (HR 2810) without any of the extenders. Another version of doc fix legislation, H.R.4302 - Protecting Access to Medicare Act of 2014, was approved by the House and Senate on March 28 and March 31. This bill prevents the 24% cut in reimbursement to doctors, extends Medicare work Geographic Practice Cost Index (GPCI) floor for 1 year; Delays the transition to ICD-10 under the Medicare program for 1 year. Transitional Fund for SGR Reform: Uses the $2.3 billion set aside for SGR in the Bipartisan Budget Act of 2013. Ensuring Accurate Values for Physician Fee Schedule Services: Allows the Secretary of Health and Human Services to use information received from medical providers and other sources to adjust code pricing to address mis-valued codes used under the Medicare Physician Fee Schedule. Medicare Pay for Value --Provider accountability for quality and spending growth is an essential element of delivery system reform. Existing law requires that the Centers for Medicare & Medicaid Services (CMS) implement a value modifier that applies to Medicare Part B physician payments for certain physicians and physician groups beginning in calendar year 2015. By 2017, CMS is required to apply the value modifier to all Medicare Part B payments to physicians and physician groups. We recommend that Congress should implement this policy sooner if possible. Score-able savings might be achieved if Congress put a larger percentage of the value modifier at risk for participating physicians, and imposed penalties on inefficient practices. Geographic Adjustment of Physician Payments-- Recent findings by the Institute of Medicine and the Medicare Payment Advisory Commission have demonstrated significant shortcomings in the data utilized to geographically adjust physician payments. The IOM and MedPAC studies have confirmed that the data sources currently relied upon for geographic adjustment bear no correlation to physician earnings. . CMS officials have admitted that the proxies utilized for the purpose of geographic adjustment have never been validated, and there never has been a new data source utilized in the twenty years since the fee schedule was implemented. MedPAC data show that the geographic adjustment reference occupations predict earnings of rural physicians to be 25-30% less than physicians in metropolitan areas. MedPAC data show that earnings of primary care physicians in rural areas are, in fact, 13% higher than physicians in metropolitan areas. Since there is no statistical basis of support for disparities in payment we strongly recommend that Congress require CMS to correct this inequity immediately. Having a source of credible data and a sustainable payment mechanism is critical to maintaining access to primary care services in rural areas for patients who reside in those areas.Dental Access -Wisconsins current record of providing dental care to children from poor households is among the worst in the nation. Marshfield Clinic hopes to improve the oral and general health of underserved residents in rural and small urban communities within the State. Marshfield Clinic in partnership with Family Health Center of Marshfield, Inc. is currently operating 8 dental clinics with another under construction. The dental facilities provided access to more than 46,000 predominately low-income uninsured or publically insured residents last year. CBO Scoring of Preventive Health The budget process should be improved to permit Congress to assess long-term health savings that are possible from preventive health initiatives. Recent research supports the premise that the current budget window should be extended and CBO directed to take into account the relevant disease-progression data that exists which demonstrates savings in preventive health. To ensure that CBOs projections on cost savings are tied to scientific data, preventive health analysis must include credible and publicly available epidemiological projection, incorporating clinical trials or observational studies in humans, longitudinal studies, and meta-analysis. This narrow approach will discourages abuse while encouraging a sensible review of health policy Congress believes will further public health. Value Based Purchasing The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. Recommendations: Medicare and other payors must capture the data on performance measures utilizing available claims-based data, and/or data recoverable through enhanced IT functions, and validate performance improvement. Implement quality/efficiency based payments for physician services as soon as possible. Implement bundled payments for episodes of care. Implement FFS reimbursement for the value added through care management and coordination of services. Improve reimbursement for primary care services. Comparative Effectiveness/Evidence Based Medical Informatics Research Evidence-based medicine relies upon the judicious use of current best evidence in making decisions about the care of individual patients. Key to effective implementation of value-based purchasing initiatives is the systematic development of data that links the health of populations to the medical services the population receives. The application of health information technology and genomic information in population- and community-based health care delivery systems coupled with the development of wellness programs has the potential to substantially improve health and personalized health care on a national basis. Recommendation: Promote evidence-based medicine as the basis for coverage decisions. Advance Care Planning - Medicare and Medicaid must incorporate advance care planning to respect and inform all caregivers of a patients healthcare choices at the end stages of their lives. It is important that the Federal programs improve the continuity of care and quality of life while maintaining respect for patients wishes. Understanding and honoring patients wishes at the end of life is paramount to ensure they are receiving appropriate care that is aligned with the personal choice and goals. We urge Congress to incorporate advance care planning discussions with health providers as a covered Medicare and Medicaid annual wellness benefit. There may or may not cost savings achieved depending on an individual patients wishes. More importantly, the discussions are necessary to assure that an individual patients desires for care at the end of life are being met and respected. Variations in Health Care Service and Distribution -- Research conducted the Medicare Payment Advisory Commission and the Dartmouth School of Medicine has documented glaring variations in how medical resources are distributed and used in the United States. Medicare pays many hospitals and their doctors much more than what it pays the most efficient and effective health care institutions to treat chronically ill people, yet they still get worse results. The extent of variation in Medicare spending, and the evidence that more care does not result in better outcomes, should lead us to ask if some chronically ill Americans are getting more care than they actually want or need. Personalized Medicine Personalized medicine, the tailoring of medical treatments to patient characteristics, relies upon the ability to classify individuals into subpopulations that differ in disease susceptibility and treatment responses. It allows clinicians to target preventive or therapeutic interventions on those who will benefit, and thereby to spare the expense and side effects of treatment for those who will not, thus making medicine more efficient. If the multiple population groups in the United States and elsewhere in the world are to benefit fully and fairly from such research, a national resource operated as a trust for the public good must be established to conduct a large populationbased cohort study that includes full representation of minority populations. The Federal government should make critical investments in the enabling tools and resources essential to moving beyond genomic discoveries to personalized medicine services of patient and public benefit.Caring for people with chronic disease now accounts for more than 75 percent of all health-care spending. Over-use and overspending is not just a Medicare problemthe health-care system as a whole lacks efficient, effective ways of caring for people with severe chronic illnesses. If the U.S. health care system mirrored the practice patterns of the most efficient/effective health care institutions, Medicare and other payors could save billions of dollars annually. Medicare Payment Inequities In the traditional fee-for-service system Medicare currently reimburses for units of service, in a manner that promotes service utilization without regard to quality. This has had the effect of economically stimulating growth in the numbers of supply-sensitive services provided by physicians. The Update formula for physician services is inequitable because it treats all physicians and regions of the country alike regardless of their individual volume influencing behavior. If the problem of cost is related to the volume of services provided, shouldnt payment be volume adjusted for specific localities? Why should conservative practices and States be punished for the excessive volume of other localities? Payment Equity for Physician Work There is no difference in the work of physicians in different locations regardless of where the work occurs. We believe that physician work should not be adjusted for geographic location. What is the rational for paying physicians more in many geographic areas when those same areas have apparently ample numbers of physicians and their wages are trending below physician wages in other areas? Should the Medicare program subsidize physicians who chose to live in high cost areas? Recommendation: the geographic adjustment of physician work should be eliminated entirely on a Budget neutral basis. Transparency Marshfield Clinic supports The Quality Data, Quality Healthcare Act, S. 1758, introduced by Senators Tammy Baldwin (D-WI) and John Thune (R-SD). This legislation would provide for greater access to Medicare claims data by modernizing and reforming the Qualified Entity (QE) program, which permits organizations to access and analyze Medicare data. Medicare Advantage Performance Measurement The Medicare Advantage program provides a capitated reimbursement to health plans for all Medicare benefits provided to enrolled beneficiaries. We believe that mechanisms for rewarding value in the Medicare Advantage program should offer incentives for those plans that demonstrate superior patient care performance. We recommend that performance bonuses should be provided for plans that: Achieve predetermined quality performance targets; Adopt health information technology; Meet standards for care coordination; and Provide data on comparative effectiveness. Medicare Advantage Call Letter On Feb 7, 2014, CMS released the "Call letter"- its annual advance notice regarding 2015 Medicare Advantage and Part D plan rates. In the Call letter: CMS described changes in the MA national per capita growth percentage for aged and disabled enrollees, and change in fee-for-service per capita costs; coding adjustment for MA plans; payment rebate amounts for plans; and an updated model of its CMS-HCC risk adjustment formula to reflect updated data and clinical revisions to diagnoses. Analysts have projected that the combined effect of the many changes could lead to Medicare Advantage payment adjustments netting negative 6-710%. Marshfield Clinic expressed the concern that the combined effect of the slate of reductions in the Call Letter will destabilize the Medicare Advantage program and undermine beneficiaries faith in their plans. Medicare Advantage Improvements H.R. 2753, THE SECURING CARE FOR SENIORS ACT, by Rep. Diane Black (R-TN), provides seniors with more choice and allows flexibility for plans in the highly successful Medicare Advantage (MA) program through common-sense and technical fixes expanding the Open Enrollment Period; Permitting Incentives for Participation in Health Care Improvement Programs; enabling Cost-sharing Variation; making Improvements to the Risk Adjustment System; and making Improvements to MA 5-Star Quality Rating System. Marshfield Clinic supports this bill. Medicaid Block Grants On March 21, 2013 the House approved Rep. Paul Ryans budget proposal for FY 2014, entitled "The Path to Prosperity. Ryan's proposal does not have the force of law but of special interest is Ryans proposal for Medicaid block grants which will come before the Energy and Commerce Committee. Under the Ryan proposal, starting in 2014, the federal share of all Medicaid payments would be paid to the states as a block grant. Chairman Ryan has projected savings to federal government that would result from reduced funding to states. The Clinic does not support this proposal in its present form. Loan Forgiveness Congress must continue to fund loan forgiveness for health profession shortage areas. The program funding should be regardless of HPSA ranking to ensure rural areas as well as urban areas can attract and staff an adequate workforce. S.T.E.M. Programming in High Schools and CollegesThe Department of Education should work in partnership with HRSA to promote change within accrediting bodies and states to create such programming. Distance learning technology should be seen as an alternative to cost prohibitive face to face curriculum. Incentives should for incorporating such technology should be considered.Premium support On March 21, 2013, the House approved Rep. Paul Ryans budget proposal for FY 2014, entitled "The Path to Prosperity. Ryan's budget does not have the force of law but tees up consideration of various reform proposals which may be considered later this year. With regard to health care, the Ryan plan calls for a major withdrawal of the federal government from the financing of health care. One health provision of the proposal calls for conversion of the current Medicare to a premium support program. For those born in 1959 or later the traditional Medicare program starting in 2024, would be converted to a defined contribution program which has been described as a premium support program. Dual Eligibles Conflicting requirements in Medicare and Medicaid pose a barrier to care coordination for 9 million beneficiaries who are eligible for both Medicare and Medicaid (dual eligibles or duals). The lack of alignment and cohesiveness between the programs can lead to fragmented or episodic care for dual eligibles and misaligned incentives for both payers and providers, resulting in reduced quality and increased costs to both programs. We would support better alignment of benefits and incentives to improve access to care for dual eligibles and prevent cost-shifting. Changing the incentives to encourage integrated care will result in better health outcomes at a lower cost. Accountable Care Organizations The Affordable Care Act seeks to improve the quality of health care services and to lower health care costs by encouraging providers to create integrated health care delivery systems. These integrated systems will test new reimbursement methods intended to create incentives for health care providers to enhance health care quality and lower costs. One important delivery system reform is the Medicare Shared Savings Program under section 3022 of the Affordable Care Act, which promotes the formation and operation of accountable care organizations (ACOs). Under this provision, groups of providers meeting the criteria specified by the Secretary may work together to manage and coordinate care for Medicare beneficiaries through an [ACO]. Adequate Funding for CMS -- The problems facing the Medicare program stem from the nations earliest attempts to make health care services broadly available nationwide without disturbing the economic incentives that were then in place. Congress must ensure that CMS has adequate funding to provide oversight of its many programs, including its measurement of resource and input costs and full implementation of the Affordable care Act. Telemedicine in Medicare Changes to Medicare law and regulation are needed to improve equity in access for Medicare beneficiaries to services delivered via TeleHealth. Medicare beneficiaries should be allowed to receive services in telemedicine sites located in urban areas. The necessary changes would remove restrictions on originating sites by removing the rural requirement and the list of originating sites and allowing any certified Medicare facility to provide the services; current requirements that physician must bill for services from the originating site should be removed; restrictions on eligible practitioners should be removed to allow all Medicare approved practitioners to provide telemedicine services; and there should be no restrictions on which Medicare services may be provided through telemedicine. Recommendations: 1.Amend the Medicare requirement for non-MSA geographic location of the patient to allow all Medicare certified organizations as originating sites regardless of rural or metropolitan statistical area designation. 2.Alternative amend the Medicare requirement for non-MSA geographic location of the patient to allow accountable care organizations to be exempt from the MSA requirement. Community Health Centers Under Health Reform The Affordable Care Act contained a number of key provisions relating to community health centers, including new funding for the community health center program and funding to expand the National Health Service Corp. While these are mandatory funding levels, the Congress did cut the base funding levels for community health centers. Americas Health Centers like Family Health Center of Marshfield, Inc. currently serve as the health care home for more than 22 million Americans, providing comprehensive primary and preventive care services. Meaningful Use of Health Information Technology The accelerating growth in new medical knowledge, coupled with the birth of new sciences, such as genomics and personalized medicine, suggests that physicians, nurses, and other healthcare professionals will invariably continue to fall further and further behind in their ability to keep up with the latest discoveries and approved treatments. As information technology has sparked this explosive growth in knowledge, only information technology can provide an adequate response. By using evidence-based knowledge embedded in clinical decision support deployed within a well-designed workflow, physicians can manage the ever changing and growing knowledge base critical to the delivery of effective and efficient healthcare. Health IT on a broad basis is still in its infancy. Looking to what can be achieved in the future due to implementation of these systems should be our focus, and an ongoing oversight function of the Office of the National Coordinator for HIT which must be closely integrated with Medicare reimbursement.Americas Health Centers play an important role in delivering care to many Americans and could be the health care home for many more, but unless Congress and the Administration act, funding for the Health Center program will be cut by 70%. A cut of this size would force Health Centers to close their doors, lay off staff, and reduce the services they provide, leaving millions of Americans without access to the health care services they need. We ask the Congress to provide not only the funding to preserve ongoing Health Center services but to also expand this cost effective model of care to every community especially those that currently lack basic primary care services. Dental Access and Integration with Traditional Medicine --- The Institute of Medicine (IOM) released a report, Dental Education at the Crossroads: Challenges and Change in January 1995 which called for a strong cohesion between medicine and dentistry. The IOM report states that "Dentistry will and should become more closely integrated with medicine and the health care system on all levels: research, education, and patient care. The National Institutes of Health has supported research documenting the importance of oral health in the context of general health and well being. Studies have demonstrated numerous oral-systemic interactions that underscore the need for more integrated care delivery. As our nation embraces EHR technologies, science underscores the need to fully incorporate oral health within an integrated EHR. Marshfield Clinic is simultaneously addressing the issue of dental access and integration with traditional medicine. Family Health Center of Marshfield, Inc. has been providing on-site dental services since the fall of 2002 and operates eight dental sites. As part of this initiative, Marshfield Clinic has developed a comprehensive medical-dental integrated electronic health record (iEHR) environment. CattailsMD, the internally developed electronic health record at Marshfield Clinic in Wisconsin, is one of the oldest electronic medical records systems in the country, with coded diagnoses back to 1960. More recently a dental module, CattailsDental has been integrated and successfully rolled out in all of the seven dental centers across Central and Northern Wisconsin. Using technology to integrate medical and dental health records holds great promise to improve the quality, safety, efficiency, effectiveness and continuity of patient care by enhancing communication and teamwork between physicians and dentists. A comprehensive approach to primary care delivery, demonstrated by Marshfield Clinic and community health centers nationwide, can best be supported with an equally comprehensive EHR infrastructure for both medical and dental records. GME Residency Expansion ---Marshfield Clinic is concerned about having a sufficient supply of primary care physicians in order to meet the demands of an expanding and aging population. This is doubly true for patients and health systems in a rural setting. Currently only about 10% of physicians practice in rural areas while 25% of the population resides there. While 36% allopathic residents and 50% osteopathic residents who are trained in a rural residency end up practicing in a rural area, only 4% of the residency training actually occurs in rural areas. As of 2012, there are more US medical students graduating from medical school than there are GME slots. An increase in GME primary care training positions is essential to maintaining high-quality, accessible, and cost efficient care. GME Funding Models Should Include Non-Hospital Sites and Interprofessionalism --- As a rural community based GME partner, Marshfield Clinic would welcome an opportunity to collaborate with Health and Human Services and other external GME partners in developing and implementing strategies for effective use of CMS and HRSA funding for expanding graduate medical education programs. This could include a shift from hospital based payment mechanisms for GME to ambulatory and community health center training locations. This would particularly help rural and underserved areas establish GME training programs. Additionally, given that teaming in healthcare is an essential element of achieving cost and quality opportunities, incentives should be developed for programs that incorporate inter-professional, team based training programs, and iEHR training. Oral Health Coverage for the Medically Compromised and at Risk Populations There is sufficient data that demonstrates oral health impacts the systemic health of the patient and in doing can reduce the cost of care. Linkages that encourage patient compliance, patient education, provider education, and bi-directional referral and surveillance should be incented and compensated. Shared savings demonstrations should be developed for health systems and co-pay incentives developed for patients engaging in and complying with such inter-disciplinary care. Simulation Program Development The Accreditation Council on Graduate Medical Education (ACGME) Program Requirements for Resident Education in Internal Medicine has recommended that residency programs need to Provide residents with access to training using simulation. Marshfield Clinic will support legislation to initiate, maintain and grow medical simulation programs through the identification of simulation centers of excellence, advancement of simulation technologies, allocation of grant funds for institutions who train healthcare providers and call together key leaders to discuss the direction of medical simulation.
2014 · first_quarter · Health Issues
Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Health care coverage and payment options in tax reform discussions Policies affecting nurse practitioner education and workforce Definition of essential health benefits Health information technology and electronic health records Mental health services and violence prevention Draft legislation on reauthorization of the National Quality Forum H.R. 7 - No Taxpayer Funding for Abortion Act H.R. 297/S. 1557 - Childrens Hospital GME Support Reauthorization Act H.R. 628/S. 195 - Mental Health in Schools Act H.R. 1249/S. 1756 - Common Sense Nutrition Disclosure Act H.R. 1281/S. 1417 - Newborn Screening Saves Lives Reauthorization Act H.R. 1427 - Truth in Healthcare Marketing Act H.R. 1791 - Medical Preparedness Allowable Use Act H.R. 1947/H.R. 2642 - Federal Agriculture Reform and Risk Management (FARRM) Act H.R. 2019 - Gabriella Miller Kids First Research Act H.R. 2279 - Reducing Excessive Deadline Obligations Act H.R. 2285 - Strategies to Address Antimicrobial Resistance Act H.R. 2575 - Save American Workers Act H.R. 2663/S. 1422 - To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.R. 3102 - Nutrition Reform and Work Opportunity Act H.R. 3147 - Food Labeling Modernization Act H.R. 3304/S. 1197 - National Defense Authorization Act (Section 1725) H.R. 3306 - Telehealth Enhancement Act H.R. 3527 - Poison Center Network Act H.R. 3717 - Helping Families in Mental Health Crisis Act H.R. 3742 - Antibiotic Development to Advance Patient Treatment (ADAPT) Act H.R. 4118 - Suspending the Individual Mandate Penalty Law Equals (SIMPLE) Fairness Act S. 264/H.R. 1263 - Excellence in Mental Health Act S. 689 - Mental Health Awareness and Improvement Act S. 696 - Safe Chemicals Act S. 744/H.R. 15 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 954 - Agriculture Reform, Food, and Jobs Act S. 1009 - Chemical Safety Improvement Act S. 1014 - Youth Sports Concussion Act S. 1086 - Safe Child Care Act/Child Care and Development Block Grant Reauthorization Act S. 1152 - Building a Health Care Workforce for the Future Act S. 1417 - Newborn Screening Saves Lives Act S. 1758 - Quality Data, Quality Healthcare Act S. 1932/H.R. 3890 - Better Care, Lower Cost Act S. 2229 - Expanding Primary Care Access and Workforce Act
2014 · first_quarter · Health Issues
S. 2157, the Commonsense Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 H.R. 2019 Gabriella Miller Kids First Research Act H.R. 1037 Occupational Therapy in Mental Health Act H.R. 1178 Creating Access to Residency Education Act of 2013H.R. 1180 Resident Physician Shortage Reduction Act of 2013 H.R. 1201 Training Tomorrow's Doctors Act H.R. 1252 Physical Therapist Workforce and Patient Access Act of 2013 H.R. 1274 Access to Quality Diabetes Education Act of 2013 H.R. 1326 Health Care Price Transparency Promotion Act of 2013 H.R. 1339 Palliative Care and Hospice Education and Training Act H.R. 1427 Truth in Healthcare Marketing Act of 2013 H.R. 1790 Health IT Modernization for Underserved Communities Act of 2013 H.R. 1814 Equitable Access to Care and Health (EACH) Act H.R. 1821 Registered Nurse Safe Staffing Act of 2013 H.R. 1827 Pediatric Subspecialty and Mental Health Workforce Reauthorization Act of 2013 H.R. 1838 Enhanced Access to Medicaid Services Act of 2013 H.R. 1874 Pro-Growth Budgeting Act H.R. 1907 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2013 H.R. 1976 Access to Certified Professional Midwives Act of 2013 H.R. 2131 Supplying Knowledge-based Immigrants and Lifting Levels of STEM (SKILLS) Visas Act of 2013 H.R. 235 Veteran Emergency Medical Technician Support Act of 2013 H.R. 2415 Treat and Reduce Obesity Act H.R. 244 Physician Availability Act of 2013 H.R. 2453 Medicare Beneficiary Preservation of Choice Act of 2013 H.R. 2484 Conrad State 30 and Physician Access Act H.R. 2619 Medicare Repiratory Therapist Access Act of 2013 H.R. 2651 Critical Care Assessment and Improvement Act of 2013 H.R. 2663 Preventive Health Savings Act H.R. 2801 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2810 Medicare Patient Access and Quality Improvement Act of 2013 H.R. 2843/S. 1180 Medicare Data Access for Transparency and Accountability Act H.R. 2867 Medicare Hospice Care Access Act of 2013 H.R. 2969 Medicare Patient Access to Hospice Act of 2013 H.R. 297 Children's Hospital GME Support Reauthorization Act of 2013 H.R. 2986 Protecting Access to Primary Care Act H.R. 3077 TELEmedicine for MEDicare Act of 2013 or TELE-MED Act of 2013 H.R. 3120 Comprehensive Dental Reform Act of 2013 H.R. 3303 Sensible Oversight for Technology which Advances Regulatory Efficiency (SOFTWARE) Act H.R. 3306 Telehealth Enhancement Act of 2013 H.R. 3362, Exchange Information Disclosure Act H.R. 3392 Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013 H.R. 3474 Hire More Heroes Act of 2013 H.R. 3507 21st Century Care for Military and Veterans Act H.R. 3717, the Helping Families in Mental Health Crisis Act of 2013 H.R. 3811, Health Exchange Security and Transparency Act H.R. 3979 Protecting Volunteer Firefighters and Emergency Responders Act of 2014 H.R. 4106, Barr-Bera Saving Lives, Saving Costs Act H.R. 4118, The SIMPLE Fairness Act H.R. 4160 - the "Keep the Promise to Seniors Act of 2014." H.R. 4177: a bill to amend the Internal Revenue Code of 1986 to Allow Medicare beneficiaries participating in a Medicare Advantage MSA to contribute their own money to their MSA. H.R. 4180: a bill to amend the Internal Revenue Code of 1986 to permit rollovers from health savings accounts to Medicare Advantage MSAs H.R. 4196: Seniors' Fairness Act of 2014H.R. 4201: Seniors' Rights to Know Act H.R. 487 Primary Care Workforce Access Improvement Act of 2013 H.R. 574 Medicare Physician Payment Innovation Act of 2013 H.R. 7, No Taxpayer Funding for Abortion Act H.R. 794 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. H.R. 962 Medicare Diabetes Prevention Act H.R. 2575, the "Save American Workers Act of 2014," H.R. 4064, FAIR ACT of 2014 H.R. 4302, the Protecting Access to Medicare Act of 2014 H.RES.356 A resolution recognizing that access to hospitals and other health care providers for patients in rural areas of the United States is essential to the survival and success of communities in the United States. H.R.1024 The Medication Therapy Management Empowerment Act IMPACT Act of 2014 (Improving Medicare Post-Acute Care Transformation Act of 2014) S. 1060 Veterans to Paramedics Transition Act S. 1061 Veterans Access to Care Act S. 1064 Medicare Mental Health Access Act S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act S. 1152 Building a Health Care Workforce for the Future Act S. 1184 Treat and Reduce Obesity Act S. 1193 Data Security and Breach Notification Act of 2013 S. 1228 Medicare Better Health Rewards Program Act S. 1422 Preventive Health Savings Act S. 1439 Care Planning Act of 2013 S. 1444 Medicare Access to Rural Anesthesiology Act of 2013 S. 1445 National Health Service Corps Improvement Act of 2013 S. 1475 National Nurse Act of 2013 S. 1517 Behavioral Health Information Technology Act of 2013 S. 1522 Comprehensive Dental Reform Act of 2013 S. 1557 Children's Hospital GME Support Reauthorization Act of 2013 S. 1685 Behavioral Health Information Technology Coordination Act of 2013 S. 1729 - Expanded Consumer Choice Act S. 1758 Quality Data, Quality Healthcare Act of 2013 S. 1871, SGR Repeal and Medicare Beneficiary Improvement Act of 2013 S. 2000/H.R. 4015 SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2007, Preventing Regulatory Overreach To Enhance Care Technology Act of 2014 (PROTECT Act) S. 2110, SGR Repeal and Medicare Provider Payment Modernization Act of 2014 S. 2166 Treating Families Fairly Act S. 2168 amends the definition from 50 100 employees for the purposes of the employer mandate S. 2173 the CHOICE Act S. 2175 Enhancing Access to Agents and Brokers Act S. 2240 The Medicare Choices Empowerment and Protection Act S. 236 Medicare Patient Empowerment Act S. 328 Strengthening Rural Access to Emergency Services Act S. 382 A bill to amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs.S. 452 Medicare Diabetes Prevention Act S. 557 The Medication Therapy Management Empowerment Act S. 577 The Resident Physician Shortage Reduction Act of 2013 S. 602 Physical Therapist Workforce and Patient Access Act of 2013 S. 616 Conrad State 30 and Physician Access Act S. 641 Palliative Care and Hospice Education and Training Act S. 739 National Nursing Shortage Reform and Patient Advocacy Act S. 744 Border Security, Economic Opportunity, and Immigration Modernization Act S. 755 Enhanced Access to Medicaid Services Act of 2013 S. 945 Access to Quality Diabetes Education Act of 2013 S.1067 Innovation Inspiration School Grant Program Act S.1897 Personal Data Privacy and Security Act of 2014 S.1927 The Data Security Act of 2014 S.1932/H.R. 3890 The Better Care, Lower Cost Act S.1976 Data Security and Breach Notification Act of 2014 S.1995 Personal Data Protection and Breach Accountability Act S.2106, FAIR Act of 2014 S.236 / H.R. 1310 - Medicare Patient Empowerment Act of 2013 S.577 Resident Physician Shortage Reduction Act of 2013 S.RES.26 A resolution recognizing that access to hospitals and other health care providers for patients in rural areas of the United States is essential to the survival and success of communities in the United States.
2013 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Draft legislation to repeal the Medicare sustainable growth rate and reform fee-for-service payment Delay of the scheduled implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare hospice certification requirements Medicare skilled nursing facility conditions of participation Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration H.R. 351/S. 351 Protecting Seniors Access to Medicare Act H.R. 574 Medicare Physician Payment Innovation Act H.R. 2504/S. 1332 Home Health Care Planning Improvement Act H.R. 2524/S. 1228 Medicare Better Health Rewards Act H.R. 2810 Medicare Patient Access and Quality Improvement Act H.R. 2817 Protect Patient Access to Quality Health Professionals Act H.R. 2986 Protecting Access to Primary Care Act S. 1143/H.R. 2810 Protecting Access to Rural Therapy Services (PARTS) Act S.1758 Quality Data, Quality Healthcare Act S. 1871 SGR Repeal and Medicare Beneficiary Access Act
2013 · fourth_quarter · Health Issues
H.R.2775 Continuing Appropriations Act, 2014 H.J. Res 59 Bipartisan Budget Act of 2013 H.R. 2810 The Medicare Patient Access and Quality Improvement Act of 2013 H.R. 3077 TELE-MED Act of 2013H.R. 3303 Sensible Oversight for Technology which Advances Regulatory Efficiency (SOFTWARE) Act H.R. 2725 FDA Safety Over Sequestration Act H.R. 3204 Drug Quality and Security Act H.R. 2651 Critical Care Assessment and Improvement Act of 2013 S. 1439 Care Planning Act of 2013 S. 1193 Data Security and Breach Notification Act of 2013 S.1927 The Data Security Act of 2014 H.R. 3696 National Cybersecurity and Critical Infrastructure Protection Act of 2013 H.R. 3811 Healthcare Exchange Security and Transparency Act of 2014 S.1897 Personal Data Privacy and Security Act of 2014 H.R. 1326 Health Care Price Transparency Promotion Act of 2013 H.R. 2651 Critical Care Assessment and Improvement Act of 2013 H.R. 2843 Medicare Data Access for Transparency and Accountability Act S. 1180 Medicare Data Access for Transparency and Accountability Act S. 1758 Quality Data, Quality Healthcare Act of 2013 H.R.3367 To amend section 9010 of the Patient Protection and Affordable Care Act to delay the application of the health insurance provider annual fee until 2016 and to provide a process to return to consumers any amounts attributable to the expected application of the annual fee to 2014 or 2015 H.R. 1037 Occupational Therapy in Mental Health Act H.R. 3120 Comprehensive Dental Reform Act of 2013 H.R. 3306 Telehealth Enhancement Act of 2013 H.R. 3507 21st Century Care for Military and Veterans Act H.R. 487 Primary Care Workforce Access Improvement Act of 2013 H.R. 574 Medicare Physician Payment Innovation Act of 2013 H.R. 1180 Resident Physician Shortage Reduction Act of 2013 H.R. 1201 Training Tomorrow's Doctors Act H.R. 1252 Physical Therapist Workforce and Patient Access Act of 2013 H.R. 1274 Access to Quality Diabetes Education Act of 2013 H.R. 1339 Palliative Care and Hospice Education and Training Act H.R. 1427 Truth in Healthcare Marketing Act of 2013 H.R. 1790 Health IT Modernization for Underserved Communities Act of 2013 H.R. 1821 Registered Nurse Safe Staffing Act of 2013 H.R. 1827 Pediatric Subspecialty and Mental Health Workforce Reauthorization Act of 2013 H.R. 1838 Enhanced Access to Medicaid Services Act of 2013 H.R. 1907 Nurse Staffing Standards for Patient Safety and Quality Care Act of 2013 H.R. 1976 Access to Certified Professional Midwives Act of 2013 H.R. 2131 Supplying Knowledge-based Immigrants and Lifting Levels of STEM (SKILLS) Visas Act of 2013 H.R. 235 Veteran Emergency Medical Technician Support Act of 2013 H.R. 244 Physician Availability Act of 2013 H.R. 2484 Conrad State 30 and Physician Access Act H.R. 2619 Medicare Repiratory Therapist Access Act of 2013 H.R. 2801 Protecting Access to Rural Therapy Services (PARTS) Act H.R. 2867 Medicare Hospice Care Access Act of 2013 H.R. 2969 Medicare Patient Access to Hospice Act of 2013 H.R. 297 Children's Hospital GME Support Reauthorization Act of 2013 H.R. 2986 Protecting Access to Primary Care ActH.R. 794 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. 1060 Veterans to Paramedics Transition Act S. 1061 Veterans Access to Care Act S. 1064 Medicare Mental Health Access Act S. 1143 Protecting Access to Rural Therapy Services (PARTS) Act S. 1152 Building a Health Care Workforce for the Future Act S. 1444 Medicare Access to Rural Anesthesiology Act of 2013 S. 1445 National Health Service Corps Improvement Act of 2013 S. 1475 National Nurse Act of 2013 S. 1517 Behavioral Health Information Technology Act of 2013 S. 1522 Comprehensive Dental Reform Act of 2013 S. 1557 Children's Hospital GME Support Reauthorization Act of 2013 S. 1685 Behavioral Health Information Technology Coordination Act of 2013 S. 236 Medicare Patient Empowerment Act S. 328 Strengthening Rural Access to Emergency Services Act S. 382 A bill to amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. S. 602 Physical Therapist Workforce and Patient Access Act of 2013 S. 616 Conrad State 30 and Physician Access Act S. 641 Palliative Care and Hospice Education and Training Act S. 739 National Nursing Shortage Reform and Patient Advocacy Act S. 755 Enhanced Access to Medicaid Services Act of 2013 S. 945 Access to Quality Diabetes Education Act of 2013 S.577 Resident Physician Shortage Reduction Act of 2013 S. 744 Border Security, Economic Opportunity, and Immigration Modernization Act H.R. 2663 Preventive Health Savings Act S. 1422 Preventive Health Savings Act S. 1228 Medicare Better Health Rewards Program Act S. 1184 Treat and Reduce Obesity Act H.R. 2415 Treat and Reduce Obesity Act H.R. 2810 Medicare Patient Access and Quality Improvement Act H.R. 2642 Federal Agriculture Reform and Risk Management (FARRM) Act S. 954 Agriculture Reform, Food and Jobs Act
2013 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing HealthDraft legislation to repeal the Medicare sustainable growth rate and reform fee-for-service payment Delay of the scheduled implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare hospice certification requirements Medicare skilled nursing facility conditions of participation Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration H.R. 351/S. 351 Protecting Seniors Access to Medicare Act H.R. 574 Medicare Physician Payment Innovation Act H.R. 2504/S. 1332 Home Health Care Planning Improvement Act H.R. 2524/S. 1228 Medicare Better Health Rewards Act H.R. 2810 Medicare Patient Access and Quality Improvement Act H.R. 2817 Protect Patient Access to Quality Health Professionals Act H.R. 2986 Protecting Access to Primary Care Act S. 1143/H.R. 2810 Protecting Access to Rural Therapy Services (PARTS) Act S.1758 Quality Data, Quality Healthcare Act S. 1871 SGR Repeal and Medicare Beneficiary Access Act
2013 · fourth_quarter · Health Issues
Legislation and policies relating to: Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Section 2706 of the ACA regarding provider non-discrimination Health care coverage and payment options in tax reform discussions Policies affecting nurse practitioner education and workforce Definition of essential health benefits Health information technology and electronic health records Mental health services and violence prevention Draft legislation on reauthorization of the National Quality Forum H.R. 297/S. 1557 - Childrens Hospital GME Support Reauthorization Act H.R. 628/S. 195 - Mental Health in Schools Act H.R. 1249/S. 1756 - Common Sense Nutrition Disclosure Act H.R. 1427 - Truth in Healthcare Marketing Act H.R. 1947/H.R. 2642 - Federal Agriculture Reform and Risk Management (FARRM) Act H.R. 2019 - Kids First Research Act H.R. 2285 - Strategies to Address Antimicrobial Resistance Act H.R. 2575 - Save American Workers Act H.R. 2663/S. 1422 - To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings H.R. 3102 - Nutrition Reform and Work Opportunity Act H.R. 3147 - Food Labeling Modernization Act H.R. 3304/S. 1197 - National Defense Authorization Act (Section 1725) H.R. 3306 - Telehealth Enhancement Act H.R. 3527 - Poison Center Network Act H.R. 3717 - Helping Families in Mental Health Crisis Act H.R. 3742 - Antibiotic Development to Advance Patient Treatment (ADAPT) Act S. 264/H.R. 1263 - Excellence in Mental Health Act S. 689 - Mental Health Awareness and Improvement Act S. 696 - Safe Chemicals Act S. 744/H.R. 15 - Border Security, Economic Opportunity, and Immigration Modernization Act S. 954 - Agriculture Reform, Food, and Jobs Act S. 1009 - Chemical Safety Improvement Act S. 1086 - Child Care and Development Block Grant Act S. 1152 - Building a Health Care Workforce for the Future Act S. 1417 - Newborn Screening Saves Lives Act S. 1758 - Quality Data, Quality Healthcare Act
2013 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Draft legislation to repeal the Medicare sustainable growth rate and reform fee-for-service payment Delay of the scheduled implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration H.R. 351/S. 351 - Protecting Seniors Access to Medicare Act H.R. 574 - Medicare Physician Payment Innovation Act H.R. 1698 - Stabilize Medicaid and CHIP Coverage Act H.R. 2504/S. 1332 - Home Health Care Planning Improvement Act H.R. 2524/S. 1228 - Medicare Better Health Rewards Act H.R. 2810 - Medicare Patient Access and Quality Improvement Act H.R. 2817 - Protect Patient Access to Quality Health Professionals Act H.R. 2986 - Protecting Access to Primary Care Act S. 1143/H.R. 2810 - Protecting Access to Rural Therapy Services (PARTS) Act S. 1758 - Quality Data, Quality Healthcare Act S. 1871 - SGR Repeal and Medicare Beneficiary Access Act
2013 · fourth_quarter · Medicare/Medicaid
Legislation and policies related to: Physician/nurse practitioner reimbursement Provisions of the Patient Protection & Affordable Care Act (P.L. 111-148) Adoption of recommendations of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health Draft legislation to repeal the Medicare sustainable growth rate and reform fee-for-service payment Delay of the scheduled implementation of Medicare durable medical equipment documentation requirements Medicare Shared Savings Program beneficiary assignment requirements Medicare hospice certification requirements Medicare skilled nursing facility conditions of participation Medicare-Medicaid hospital conditions of participation Draft legislation on admission of advanced practice registered nurses to hospital medical staff and granting of clinical privileges Provisions of the 2013 Medicare fee schedule final regulations Draft legislation to require states to recognize nurse practitioners as primary care case managers and as primary care providers in managed care plans Draft legislation to extend Medicaid incentives to adopt electronic health records to nurse-managed health clinics Evaluation of the Medicare Graduate Nurse Education demonstration Medicare-Medicaid Program Integrity policies Medicaid maintenance of effort requirements Medicaid eligibility expansion and state options Medicaid waiver application procedures Medicaid per capita cap policy options Medicare-Medicaid dual eligible coverage and demonstration H.R. 351/S. 351 - Protecting Seniors Access to Medicare Act H.R. 574 - Medicare Physician Payment Innovation Act H.R. 2504/S. 1332 - Home Health Care Planning Improvement Act H.R. 2524/S. 1228 - Medicare Better Health Rewards Act H.R. 2810 - Medicare Patient Access and Quality Improvement Act H.R. 2817 - Protect Patient Access to Quality Health Professionals Act H.R. 2986 - Protecting Access to Primary Care Act S. 1143/H.R. 2810 - Protecting Access to Rural Therapy Services (PARTS) Act S. 1758 - Quality Data, Quality Healthcare Act S. 1871 - SGR Repeal and Medicare Beneficiary Access Act
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), 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), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
Client expense: $90,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), 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), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE
Client expense: $80,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), 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), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office
Client expense: $120,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE
Client expense: $117,584 · 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), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $180,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), SENATE, Treasury, Dept of
Client expense: Not reported · Firm income: $23,450
Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), 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), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $160,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $101,617 · 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), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: $160,000 · Firm income: Not reported
Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Client expense: $101,618 · 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), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: Not reported · Firm income: $23,450
Government targets: 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), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: Not reported · Firm income: $23,450
Government targets: 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), Office of Management & Budget (OMB), SENATE, White House Office
Client expense: Not reported · Firm income: $15,625
Government targets: 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), SENATE, White House Office