July 6, 2009

2009

July 6, 2009

CMS Issues Proposed Physician Fee Schedule for 2010

This week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for physician Medicare Part B services for 2010. The proposed rule covers a wide range of issues impacting the pulmonary, critical care and sleep community. Below is a brief summary of some of the major issues of interest to the respiratory community:

As expected, the proposed rule forecasts a 21 percent cut in Medicare physician reimbursements for 2010. This significant cut is the result of the flawed sustainable growth rate factor formula (SGR) that is used to calculate the annual update. The scope of the cut was mitigated, however, by CMS's decision to remove the cost of physician-administered drugs from the SGR calculations. This makes it easier for Congress to develop a long-term fix to the SGR problem. For several years, Congress has intervened with temporary fixes to prevent CMS from implementing the draconian cuts but has left the underlying flawed formula in place.

Fixing the flawed SGR formula is a high priority for the physician community and the SGR formula is addressed in several healthcare reform proposals being considered by Congress.

Pulmonary Rehabilitation

The proposed rule issues a new national policy for pulmonary rehabilitation coverage. Under the new policy, CMS would cover pulmonary rehabilitation for all patients with moderate and severe COPD (as defined by the GOLD guidelines). The proposed rule does not cover other fixed-airway diseases, but it does allow for the inclusion of other conditions through a notice of coverage determination (NCD) process.

The proposed rule replaces the existing 15-minute increment G-codes for pulmonary rehabilitation (G0237, G0238, G0239) with a single 1-hour code (GXX30) with a reimbursement rate $16.71 - a significant cut from the current rate. CMS is further proposing to cover up to 36 sessions and to require physicians to see the patient and sign off on the pulmonary rehabilitation every 30 days.

The ATS and sister societies will be working hard to address several aspects of the proposed pulmonary rehabilitation coverage policy, including the reimbursement rate, number of covered sessions and conditions indicated for coverage.

Pulmonary Practice Expense

In a welcomed bit of good news, the practice expense rate/hour for pulmonary physicians increased by $10.63 from $44.63 to $55.26 under the proposed rule. The increase in practice expense will result in a $52-million annual increase in Medicare payments to pulmonary physicians.

Consultations

CMS is proposing to eliminate Medicare payment for hospital inpatient and out-patient/office based consultations and, instead, incorporate the consultation code values- in a budget neutral manner - into new and established patient offices visits and initial hospital visits and initial nursing home visits.

Clean Air: EPA Proposes New Standard for Oxides of Nitrogen

Health Reform: Senate HELP Committee Begins Consideration of Health Reform

Last week, the Senate Health, Education, Labor and Pensions (HELP) Committee began intense consideration of the health reform package, the Affordable Health Choices Act. During these sessions, the committee reviewed prevention and wellness, comparative effectiveness and healthcare workforce sections of the bill.

The committee debated more than 50 amendments to the prevention and public health section of the bill, including an amendment to eliminate the bill's inclusion of a public health investment fund to strengthen the nation's public health system. Debate focused on whether prevention should be implemented primarily through the private health sector or through a coordinated investment from the federal government, as envisioned under the public health investment fund. Following extensive debate on the issue, the committee voted to retain the measure in the bill. Other amendments debated and approved for inclusion into the health reform bill included:

An initiative to provide a coordinated environmental public health network
A measure to coordinated education, research and training efforts for pain management
A measure to expand federal disease surveillance programs
A measure to include consideration of clinical preventive best practice recommendation.

The Senate HELP Committee will resume consideration of its health reform bill this week, including the quality section of the bill. The Senate Finance and House Energy and Commerce Committee are expected to begin consideration of their portions of the health reform package this week.

ATS Leadership Meets with NIH Directors

Last week, the ATS Executive Committee, J. Randall Curtis, M.D., President-Elect Dean Schraufnagel, M.D, Vice President Nicholas Hill, M.D., Past President Jo Rae Wright, Ph.D., Secretary-Treasurer Monica Kraft, M.D., and Executive Director Stephen Crane, Ph.D., M.P.H., held their annual meetings with key NIH institutes and federal agencies to promote respiratory, critical care and sleep research and collaborations between the ATS and these organizations.

VA Research Program

The ATS leadership met with the Veterans Administration's Director of Research and Development, Timothy O'Leary, M.D., to discuss the VA's efforts in respiratory illnesses, critical care and sleep disorders. The ATS has built a strong relationship with the VA through its advocacy leadership on funding for the program and support for career development awards. Dr. Curtis advocated for more research support devoted to respiratory illness, particularly COPD because of the large numer of veterans with this chronic disease. Dr. O'Leary reported that VA research grant information is being incorporated in the NIH's REPORT database of grants over the next years. Currently, about 10 percent of new VA grants are already included in the system. The ATS leaders also invited the VA to participate in the 2010 ATS International Conference, which Dr. O'Leary responded to with enthusiasm.

National Institute of General Medical Sciences

The ATS met with the Director of the NIGMS, Jeremy Berg, Ph.D., for the second time to discuss the institute's critical care research agenda and encourage expansion in this area. Dr. Berg also discussed how the institute is distributing funding received through the American Reinvestment and Recovery Act, including funding some fifteen challenge grants and a number of administrative supplements to existing grants.

National Institute of Child Health and Development

The ATS leadership held a first-ever meeting with NICHD, when it met withDeputy Director Yvonne Maddox, Ph.D. The ATS leaders discussed specific areas of interest in pediatric health, particularly pediatric asthma, SIDS, environmental effects on child health and development, and pediatric sleep disorders. During the meeting, the ATS requested that the NICHD pursue data on pediatric sleep-disordered breathing through the National Children's Study, a national study of 100,000 children that will broadly examine the role of environmental effects on child health and development from pre-birth to age 21.

Agency for Health Quality and Research

ATS leadership met with staff at AHRQ to discuss comparative effectiveness research, quality research and CMS policy on ventilator- associated pneumonia and other healthcare acquired conditions. The meeting focused on different AHRQ funding mechanisms that might be of interest to the respiratory community.

Fogarty International Center

The ATS leaders' meeting with FIC research and training staff focused on ways for the ATS and the FIC to collaborate on global health research and training. The FIC's mission focuses on improving global health through research training programs in the developing world. The ATS leaders discussed how the FIC can collaborate on the ATS's MECOR (Methods in Epidemiologic, Clinical and Operations Research) training program, now in operation in Latin America, Africa, Turkey, India and Indonesia. FIC invited the ATS to participate in a Fall 2009 meeting on global climate change that the center is sponsoring with the NIEHS.

National Cancer Institute

The ATS leadership also held their second meeting with the NCI to discuss the ATS's growing interest in lung cancer. The ATS leaders discussed lung cancer detection, prevention and treatment and opportunities for collaboration on COPD and tobacco. NCI staff provided the ATS with an overview of programs related to lung cancer, including the Early Detection Network and the Specialized Programs of Research Excellence.

Environmental Protection Agency

Senior staff of the EPA Office of Air and Radiation met with the ATS leadership to discuss a wide range of issues. At the top of the list was the EPA proposed revision to the National Ambient Air Quality Standard for oxides of nitrogen, which EPA proposed last week. The ATS leadership also asked the EPA about its plans for addressing the federal court remand of the annual particulate matter standard and the revision of the ozone issued under the Bush Administration. The ATS also discussed the EPA's future plans for research, reporting and regulation of green house gases. The EPA expressed interest in getting input from the ATS about the respiratory health effects of climate change.

National Institute of Allergy and Infectious Diseases

The ATS leadership met with the NIAID Deputy Director Hugh Auchincloss, MD. Among the topics discussed werethe H1N1 flu, tuberculosis, asthma and non-tuberculous mycobacteria (NTM). Dr. Auchincloss announced that the institute intends to expand its TB research over the next few years, particularly in the area of clinical drug trials. The ATS leaders also discussed ways that the NIAID can collaborate with the ATS, including through support for the MECOR program.

Points of Contact

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