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June 13, 2008


June 13, 2008

Medicare Bill Fails Cloture Vote - But Hope Remains

Legislation to avert the looming 10% cut in Medicare physician reimburse- ment failed a procedural vote in the Senate yesterday. Supporters of Senator Baucus' (D-MT) Medicare bill (S.3101) failed to get the 60 votes necessary to invoke cloture. Nine Republicans voted to support cloture.

Both Republicans and Democrats have offered legislation that would avert the 10% cuts in Medicare payment schedule for July 1, 2008 and stave off further cuts in 2009. Both bill also include provision to enhance beneficiaries services and quality reporting. Both bill also include a provision to create a national coverage benefit for pulmonary rehabilitation.

At issue between Democrats and Republicans are which offsets should be used to pay for the bill. Democrats have proposed cuts to Medicare payments for Medicare managed care plans - which Republicans oppose - cuts to durable medical equipment providers and other provisions.

Most Congressional observers feel the two side are relatively close and will likely be able to resolve legislative difference in time to prevent the looming Medicare physician pay cut.


ATS and Sister Societies Comment on CMS Hospital Acquired Conditions Policy.

The ATS and sister organization submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding their proposal to deny Mediare payment for selected hospital acquired conditions (HACs).

Congress recently required CMS to develop a list of at least two HACs for which CMS would not pay for any complicating or major complicating add on for the base hospital payment. A list of several conditions already exists. CMS is proposing to expand the list with the following conditions:

1. Surgical Site Infections Following Specific Elective Surgeries
2. Legionnaires' Disease
3. Extreme Glycemic Aberrancies
4. Iatrogenic Pneumothorax
5. Delirium
6. Ventilator-Associated Pneumonia (VAP)
7. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
8. Staphylococcus aureus Septicemia
9. Clostridium Difficile-Associated Diseases (CDAD)

While expressing concern about all the proposed conditions, the joint comments focused on iatrogenic pneumothorax, ventilator associated pneumonia, deep vein thrombosis/pulmonary embolism and delirium. The comments noted that while each of these conditions is serious and many can be reduced, none of the conditions can be entirely prevented by application of evidence-based guidelines. As such, CMS should not develop outcomes-based payment policy on these conditions. The letter did suggest that it might be appropriate to develop process-based payment policies to encourage adoption of evidence-based guidelines. The letter also encouraged CMS to consider populations subsets for which outcomes-based policies might be more appropriately applied.

The ATS was joined on the letter by the American College of Chest Physicians, National Association for the Medical Direction of Respiratory Care, Society of Critical Care Medicine, America Association of Critical-Care Nurses, and the American Association for Respiratory Care.




OSHA Resumes TB Respiratory Fit Testing

After a congressionally enforced hiatus of three years, the Office of Occupational Safety and Health (OSHA) has resumed its requirement for annual fit testing for the respiratory protection standard. The requirement now applies to respirators used to protect health care workers from exposure to TB. For several years, Congressman Roger Wicker (R-MS) had inserted language in annual appropriations bills preventing OSHA from enforcing the fit standard as it applied to health care workers exposed to TB. The Wicker language was not accepted into the FY2008 Labor-Health and Human Services and Education Appropriations bill as enacted. On April 16, OSHA issued a memo announcing that it has resumed enforcement of fit-testing of respirators used for protection against TB.

Points of Contact

Gary Ewart Senior Director, Government Relations
Nuala Moore Senior Legislative Representative
Joe Kirby DC Office Administrator