March 7, 2007

HEADLINE

Senators Durbin and Crapo Introduce Patient-Focused Critical Care Enhancement Act, S. 718

Last week, Senators Durbin (D-IL) and Crapo (R-ID) introduced legislation to increase the supply, efficiency and organization of critical care services provided to patients. The legislation seeks to address the looming shortage of physicians that are trained to provide pulmonary and critical care services to the U.S. population.

The legislation:

• Directs the US Department of Health to conduct research on standardization staffing and coordination of critical care services, and provide recommendations to Congress within 18 months of enactment of the bill.
•  Establishes two critical care services demonstration projects that will be funded by CMS. One project will focus on how to improve critical care services to Medicare beneficiaries through innovations in such areas as staffing, Intensive Care Unit (ICU) arrangements, and utilization of new technology. The second project will focus on family-centered inpatient critical care services, including better communication with family members, involvement of family members in the critical care decision-making process, and responsiveness of critical care providers to family requests.
•  Makes critical care service providers in rural settings eligible for funding in USDA’s Distance Learning and Telemedicine Program, and authorizes $5 million in additional funding for the program for each of fiscal years 2008-2013. Telemedicine is most beneficial for those living in rural communities as it allows a general practitioner in a small town to get assistance from a specialist at a remote location.
•  Amends the National Health Service Corps Act to create an express authorization under the Loan Repayment Program for a program to recruit at least 50 critical care providers per year to provide services in medically underserved areas

In responding to the legislation, ATS President John E. Heffner MD stated, “patient care will suffer unless we find ways to both increase the efficiency of the existing critical care workforce and enhance mechanisms to train the future providers of critical care medicine. By addressing the shortage on both fronts, we believe this legislation can make great strides in addressing the critical care physician shortage.”

The Patient-Focused Critical Care Enhancement Act, S. 718, was drafted in response to concerns expressed by American Thoracic Society and our sister societies that aging U.S. population will soon require more pulmonary and critical care services than there are physicians trained to provide these services. The shortage of pulmonary and critical care providers was first projected by a study commissioned by the ATS, ACCP and SCCM and was most recently validated by a Health Resources and Services Administration study that projected a shortage of critical care providers starting in 2009 and worsening through 2020.

PHYSICIAN SUPPLY

Bill Introduced to Raise Residency Cap

In related news, Senators Reid (D-NV) and Nelson (D-FL) introduced legislation, the Resident Physician Shortage Reduction Act (S. 588), that would allow states facing resident shortages to increase the number of federally funded GME training positions. The bill defines residency shortage as any state that has a resident to population ratio below the national median. Such states would be able add additional GME funded residency positions based on an allocation formula to be developed by the Department of Health and Human Services. In awarding additional residency positions, HHS is mandated to consider whether the additional residency positions could be filled within a 3-year period. Additionally, the limits the total number of new residency positions for each state to 25% of the number needed to bring that state to the national residency to population median ratio.

If enacted, the bill could provide an additional 1,200 new GME funded-residency positions over a five year period.

CLINICAL PRACTICE

Still Time to Participate in the Smoking Cessation Survey

There is still time to participate in the survey being conducted by the American Thoracic Society (ATS) and sister pulmonary and primary care societies regarding new smoking cessation codes. The survey covers two smoking cessation counseling codes - HCPCS G0375 and G0376. These codes will be transitioning into CPT for 2008 and the ATS has agreed to participate in the American Medical Association's RVS Update Committee (RUC) survey process that will determine a recommended relative value unit (RVU) to CMS that will affect your future Medicare Reimbursement.

If you are interested in participating in the survey for the smoking cessation code, please contact Gary Ewart, ATS at gewart@thoracic.org. The survey will take place in early March and should take 15-30 minutes to complete.

Support for Pulmonary Rehabilitation Legislation Grows

The cosponsorship support for the pulmonary rehabilitation legislation (S. 329/H.R. 552) introduced by Senators Lincoln (D-AR) and Crapo (R-ID) and Representatives Lewis (D-GA) and Pickering (R-MS) continues to grow as a result of strong grassroots outreach from the provider community. In February, ATS members were on Capitol Hill lobbying in support of the bill. In March, our colleagues at the American Association of Respiratory Care and the American Association of Cardiovascular and Pulmonary Rehabilitation were also in Washington D.C. to express support for the legislation.

To date, there are 20 cosponsors of the House bill and 9 sponsors in the Senate. Below are the current cosponsors of the legislation:

Senate Cosponsors
Jim Bunning (R-KY)
Hillary Clinton (D-NY)
Susan Collins (R-ME)
Kent Conrad (D-ND)
Byron Dorgan (D-ND)
Robert Menendez (D-NJ)
Chuck Schumer (D-NY)
Olympia Snowe (R-ME)

House Cosponsors
Tom Allen (D-ME)
Rick Boucher (D-VA)
Lois Capps (D-CA)
David Davis (R-TN)
Diane DeGette (D-CO)
Barney Frank (D-MA)
Jim Gerlach (R-PA)
Phil Gingrey (R-GA)
Bart Gordon (D-TN)
Thad McCotter (R-MI)
Todd Platts (R-PA)
Nick Rahall (D-WV)
Mike Rogers (R-MI)
John Salazar (D-CO)
Jim Saxton (R-NJ)
Lee Terry (R-NE)
Zack Wamp (R-TN)
Bob Wexler (D-FL)
Albert Wynn (D-MD)

The bill would create a pulmonary rehabilitation benefit in the Medicare statute and direct the Centers for Medicare and Medicaid Services (CMS) - which administers the Medicare program – to create a national coverage policy for pulmonary rehabilitation.

ATS members are encouraged to contact their members of Congress to express support for the pulmonary rehabilitation legislation.

TOBACCO

Senate Holds Hearing FDA Tobacco Bill

Last week, the Senate Health Education Labor and Pensions committee held a hearing on legislation granting the Food and Drug Administration (FDA) authority to regulate tobacco (S.625/H.R. 1108). The hearing featured a number of physician and public health experts who testified about significant economic, societal and health costs resulting from tobacco use and how granting FDA the authority to regulate tobacco product content, labeling, health claims and marketing will significantly reduce tobacco use in the U.S. – particular among children.

However, what made last week’s hearing unique from previous hearings on the topic was the show of support from groups outside of the public health community. Richard Land, PhD, representing the Southern Baptist Convention and the Faith United Against Tobacco coalition – coalition of 20 faith denominations and organizations – expressed strong support from the religious community for the bill as a moral issue. In his testimony, Dr. Land noted that, “There is broad consensus in the faith community, both conservative and liberal, that this product (tobacco) must be regulated, and that is why we support this bill. We also support this bill for moral reasons.”

The bill currently has 30 cosponsors in the Senate and 106 cosponsors in the House. ATS members are urged to continue their outreach to Congress expressing support for the FDA bill to regulate tobacco (S. 625/H.R.1108).

Points of Contact